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SAN JOAQUIN 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 /> ��FOFtN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation e-r /5--Z/ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection-/L 3 <br /> q10 iT. <br /> Structure Operation Manure Mana em tOW OPERATOR PHONE <br /> 11 ❑ 3. Spreading and D' king Q <br /> GRAM ELEMENT RECORD ID <br /> ❑ F1 4. Concrete Tank INSP CTION TYPE PRO <br /> 1:1 E] 5. Lagooning ®� / <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp sal <br /> ❑ ❑ 7. Burvi9dwith 2°of Cover <br /> ❑ ❑ 8. Appy6ved Concrete Tank <br /> ❑ ❑ 9. moval from Premises v <br /> Structure Operation V for Control <br /> ❑ ❑ . Domestic FI <br /> 1:1 El 11. Fannia FI <br /> ❑ ❑ 12. Larvae s <br /> ❑ ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 41 16. Moderate Population <br /> 1 ®adz P� <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs r <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Str lure Operation Houses <br /> ❑ 21. FloorsAla' o,%R/ <br /> ' ,-_ ® r <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Freuenc <br /> Structure Operation Water Well <br /> ❑ [In 1. Well Construction <br /> El 2. Cross Connection <br /> Structure Operation Floors <br /> 3. Pro erg Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑AL 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ g 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Elabies Vaccination MECEI IN P CTOR <br /> ❑ El 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />