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,O?a"I" .Co SAN JOAQUIN COUNTY 46 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �lPOR <br /> VECTOR CONTROL INSPECTION FORM <br /> 5DBA INSPECT)ON DAT <br /> Structure Operation 1 S ! <br /> ❑ ❑ 1. Well Construction SE ADDRESS(., �,/� � R -I PECTI DA E <br /> ❑ ❑ 2. Cross-Connection �� `�/ow 1°1� 'w�' YStructure Operation Manure Mana ement OP RATOR <br /> P N <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks 1 ECTPN TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning `^( <br /> ❑ ❑ 6. Composting T e items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> E] 1:17. Burying with 2"of Cover ® c <br /> ❑ 118. Approved Concrete Tank I <br /> s <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> El 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 1 13. Pupae t• <br /> ❑ ❑ 14. Adult 40 j 5 Aa-;N <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water • Q-� �"f'• <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls dw 1 • <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 1 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> El ❑ 1. Well Construction C .Q. 4 / S <br /> 2. Cross Connection / <br /> Structure Operation Floors r I N !f <br /> 3. Properly Graded to Sewer <br /> ❑ - El 4. Drain j L4 <br /> ❑ ❑ 5. Smooth/Cleanable t <br /> 6. Covin i` /S - <br /> El El 7. CleaningFrequencyC 1 <br /> Structure Operation WallS <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleanin2 Frequency 9- <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El 0 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation 1 Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INS CTO <br /> ❑ 1 ❑ 1 18. Certificate on Premises T77-AA IF 0" <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of_ <br />