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Aa"'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q..- ;..•;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<F OIZa <br /> VECTOR CONTROL INSPECTION FORM <br /> i 13'f R A ' } .a`r o Via,; DBA `. <br /> `� INSPECTION DATE <br /> Structure Operation �' 5 sat <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION ATE <br /> ❑ ❑ 2. Cross-Connection I '1 10 <br /> Structure Operation M lure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ Spreading and Disking , Q J3_r <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning yL/S C? <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal A An <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises _v <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fly m�" <br /> El ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae 2 5-r h <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ . Moderate Population <br /> ❑ ❑ J, Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls eunL <br /> EI 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> 1:1 ElI ,V►v \ <br /> 1. well Construction <br /> ❑ 2. Cross Connection <br /> Structure Operation Floors VtL4X v` <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain f <br /> 7A, yw'&YL yyy_ C') <br /> ❑ ❑ 5. Smooth/Cleanable If <br /> ❑ ❑ 6. Covinq � ,2 <br /> ❑ 7. Cleaning Frequency <br /> Structure Operation Walls -�-� <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency r <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition r <br /> 1:1 El 11. Sanitation <br /> Structure Operation Food rx fig <br /> /s <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin Vfi <br /> Structure Operation 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 REC EDB INSP R <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> Page of <br /> EHD 40-06 4/6/12 <br /> _ <br />