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OQ0.�t!v O <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> q.., Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INON p�T€ <br /> Structure Operation SPE TIl` (� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> ^ <br /> Structure Operation Manure Mana eme ow OPERATORP}�ONE <br /> El El 3. Spreading and Dis ng F ..38 - Y_?gg <br /> ❑ ❑ 4. Concrete Tanks INS PE TION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning a <br /> El E] 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo ai <br /> ❑ ❑ 7. BurvinAith 2"of Cover r <br /> ❑ ❑ 8. A ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve or control <br /> ❑ ❑ 1 Domestic FI <br /> 13 A. Fannia FI <br /> ❑ ❑ 12. Larvae > <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure peration FeedingiMater <br /> ❑ I ❑ 18. Water Troughs _ <br /> ❑ 1 ❑ 19. Cups or Bowls ' r <br /> 20. Food Storage <br /> Struc re Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilin s a <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Structure Operation y4aterA <br /> ❑ ❑ 1. Weli Construction <br /> Cross Connection <br /> Structure Operation C ( s <br /> Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable A C� <br /> 0 El 6. Covin <br /> Zj;jWing Frequency <br /> Structure Operation Wa <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cjeaning Frequency <br /> Structure Operation ages <br /> ❑ ❑ Condition <br /> ation <br /> Structure Operation 0o <br /> ❑ ❑ . Storage <br /> 3. insect/Vermin <br /> Structure Operatic, al Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 1 <br /> Structure Operatic, Sewage Disp <br /> ❑ ❑ 16. Se tic S stem <br /> ❑ ❑ . Se <br /> Structure Operation abies Vaccination RECEIVED INSP CT <br /> ❑ ❑ & Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />