Laserfiche WebLink
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 /> L/pptt� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Wei I y ✓ (,r <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 1:1 F-12. Cross-Connection 30t-S <br /> Structure Operation Manure management OWNER/OPERATOR P�HOyN�E <br /> [:] E] 3. Spreading and Disking vC'' I C� <br /> ❑ ❑ 4. Concrete Tanks INSIPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning � <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal /J! <br /> ❑ ❑ 7. Burying with 2"of Cover J 'r'C &ja1 <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control _ <br /> ❑ ❑ 10. Domestic FI M i 1►l <br /> El 11. Fannia FI <br /> ❑ ❑ 12. Larvae t. LA�cs` <br /> I <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult Y1�a <br /> ❑ ❑ 15. Light Population \ <br /> ❑ El16. Moderate Population +Z �- <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 171 El 20. Food Storage <br /> Structure Operation Houses <br /> Ele- <br /> El ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings t <br /> ❑ I ❑ 23. Cleaning Frequency <br /> CA, Lye- <br /> Structure Operation water well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors 5 <br /> ❑ ❑ 3. Pro erl Graded to Sewer \ <br /> ❑ ❑ 4. Drain yt <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ 7. Cleaning Frequencyr <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency CY <br /> Structure Operation Cages / <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food , <br /> ❑ ❑ 12. Storage <br /> El n 13. Insect/Vermin �• I <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 RECEIVED BY INS OR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 a, <br /> Page of <br /> t <br />