Laserfiche WebLink
SAN <br /> q ®® <br /> SAN JOQ 1 COUNTY <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 /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTI DAT f <br /> Structure Operation e <br /> ❑ ❑ 7Cross-Connection <br /> PREMISE ADDRESS RE-IN ECTION DATE <br /> ❑ ❑ `, <br /> Structure Operation e t OW R/OPERATO P� NE <br /> . preanganing 1! ( , {, ®-33 <br /> ❑ ❑ 4. Concrete Tanks INSP TION TYPE PROGRAM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning GREM 'P12 0 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DIspo 1 <br /> ❑ ❑ 7. Burvinq ith 2°of Cover <br /> ❑ ❑ 8. Approy6d Concrete Tank , <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation VeCto Control <br /> ❑ ❑ 10.Aomestic FI <br /> 1 11 Fannia FI <br /> ❑ ❑ A. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 10 17. Heavy Population <br /> Structure Op/ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> StructureOperation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings "- <br /> ❑ 23. Cleanin Fre uenc <br /> SKENEEMEM <br /> Structure Operatio Water We <br /> ❑ ❑ KT. Well Construction <br /> Cross Connection <br /> Structure Operation I r <br /> 1:1ro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El _Z-A:ae_aning Frequency <br /> Structure Operati a1IS <br /> ❑ 1:1Smooth/Cieanable <br /> ❑ ❑ in Fre uenc <br /> Structure Operation Cage <br /> ❑ ❑ lion <br /> El ME11 <br /> ation <br /> Structure <br /> ❑ rage <br /> El t/Vermin <br /> Structure Disposal <br /> ❑ val from Premises <br /> ❑ ❑ 15. <br /> Structure Operation Sewage DiSpsi <br /> ❑ ❑ oli6. a tic S stem <br /> ❑ ❑ <br /> Structure Operati Rabies Vaccinatld ED Y I PCT R <br /> ...._., <br /> El 1:1e ificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40706 4/6/12 1 <br /> a�.�'j' Page of 1 <br />