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Op. ..a"t" SAN J 1 COUNTY <br /> ...., <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. <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 /> �/FORD <br /> VECTOR CONTROL INSPECTION FORM <br /> FBA INSPECTION DATE <br /> Structure Operation 9I I f f° <br /> ❑ ❑ 1. Well Construction ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection Structure Operation Manure Mana erne OPERATOR PHONE <br /> 3. Spreading and Dis ng ',4. Concrete Tanks ON TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagoon ing _ �d,P$�!� ¢ 0,x'-2 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DlspoS <br /> ElEl7. Bu in wi 2"of Cover <br /> ❑ ❑ 8. ApprovelLconcrete Tank <br /> ❑ ❑ 9. Remov from Premises <br /> Structure Operation Vector gontrol <br /> ❑ ❑ 10. D estic FI <br /> El 11. F nnia FI <br /> ❑ ❑ 12. arvae / <br /> ❑ ❑ 1 . Pupae <br /> ❑ ❑ 4. Adult <br /> ❑ ❑ 15. Li ht Po ulation � ,fin <br /> ❑ ❑ 16. Moderate Po ulation <br /> ❑ ❑ 17. Heavy Population <br /> Structure Ope tion FeedingM/ater <br /> ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walis/Ceilin s <br /> ❑ 23. Cleaning Fre uenc <br /> Structure Operationer eea e ) ° <br /> ❑ ❑ bj 1. ell Construction <br /> 1:1 El 2-Crom Connection <br /> Structure Operation FI <br /> 3. Properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> 13 7_-Clpaning Frequency <br /> Structure Operation Wal v <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Ca M <br /> ❑ ❑ 10. Condition <br /> El El1 Sanitation <br /> Structure Operation Food <br /> ❑ ❑ tora e <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ Removal from Premises <br /> ❑ ❑ 15. 9th <br /> Structure Operation ewage Disposal <br /> ❑ ❑ e is stem <br /> ❑ ❑ <br /> Structure Operation Rabies Vaccination- RECE VED BY INS ECTOR <br /> ❑ ❑ ertificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />