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SAN JOAQUIN COUNTY <br />2G ENVIRONMENTAL HEALTH DEPARTMENT <br />y X <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Oq., ::,.•�P Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br />�FORa <br />VECTOR CONTROL INSPECTION FORM <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 4/6/1261 Page ) of <br />DBA A_lVet" ® <br />INSPEC�TINDA E <br />Structure <br />Operation <br />"f <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />RE -INSPECTION DATE <br />❑ <br />❑ <br />2. Cross -Connection <br />0 _. <br />Structure <br />Operation <br />Manure Mana em t <br />OWflIER/OPERATOR <br />PHONE <br />❑ <br />❑ <br />3. Spreading andD' king <br />❑ <br />El <br />4. Concrete Tank <br />INSPECTION TYPE <br />PROGRAM ELEMENT <br />RECORD ID <br />❑ <br />❑ <br />5. Lagooning <br />�!° <br />0 4.0-.0 <br />El <br />❑ <br />6. Compostinj <br />The items below represent code violations and must be corrected: <br />Structure <br />❑ <br />Operation <br />❑ <br />Bird Disp al <br />7. Bu in with 2" of Cover <br />❑ <br />❑ <br />8. A r ved Concrete Tank <br />❑ <br />❑ <br />9. R oval from Premises <br />Structure <br />operation <br />Ve or Control <br />❑ <br />❑ <br />1 . Domestic FI <br />❑ <br />❑ <br />1. Fannia FI <br />112. <br />1 p <br />/ <br />Larvae <br />�- <br />❑ <br />❑ <br />13. Pupae <br />❑ <br />❑ <br />14. Adult <br />❑ <br />15. Light Population <br />❑ <br />16. Moderate Population <br />❑ <br />❑17. <br />Heavy Population <br />Structure <br />peration <br />FeedingM/ater <br />El❑ <br />❑ <br />❑ <br />18. Water Troughs <br />19. Cups or Bowls <br />20. Food Stora e <br />Struct re <br />Operation <br />Houses <br />❑ <br />❑ <br />21. Floors <br />22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency <br />Structure <br />Operation <br />aterWI- <br />_I'Well <br />Well Construction <br />s Connection <br />Structure <br />Operetio <br />F <br />El <br />❑ <br />❑ <br />3. Property Graded to Sewer <br />DV4. <br />Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />6. Covin <br />7. ng Frequency <br />Structure <br />Operetio <br />Wa IS <br />❑ <br />❑ P, <br />9. Smooth/Cleanable <br />❑ <br />❑ <br />ing Frequency <br />Structure <br />Operation <br />Ca g <br />❑ <br />❑ <br />10. Condition <br />1. §anitation <br />Structure <br />Operatio <br />F <br />❑ <br />❑ <br />12. Storage <br />13. ermin <br />Structure <br />Operation <br />Animal I <br />❑ <br />❑ <br />4. emoval from Premises <br />❑ <br />❑ <br />15. Othe <br />Structure <br />Operation <br />ewage_pjsposal <br />❑ <br />❑ <br />e tic System <br />❑ <br />❑ <br />Structure <br />El <br />Operation <br />abies <br />RiaVED BY PT R <br />r <br />18. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 4/6/1261 Page ) of <br />