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oP0.u'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> . �. ;P• Telephone:(209) 468-3420 Fax: <br /> . (209)464-0138 Web:www.sjgov.org/ehd <br /> .rFORt� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPE TI N D E <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS , RE-IN PECTION DATE <br /> ❑ ❑ 2. Cross-Connection--/— 1.2 7.5- �- <br /> Structure Operation Manure Mana eme OWNER/OPERATOR PHONE 7? <br /> 1:1 El 3. Spreading and Dis g � ✓a / <br /> ❑ ❑ 4. Concrete Tanks INS P TION TYPE PROGRAM ELEMENT RECORD ID <br /> E] ❑ 5. Lagooning /o Y000,83 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DlspoS <br /> ❑ ❑ 7. Bu in w' 2"of Cover <br /> ❑ ❑ 8. A rov Concrete Tank <br /> ❑ ❑ 9. Remoyal from Premises <br /> Structure Operation Vector ontrol <br /> ❑ ❑ 10. Dimestic FI <br /> 13 11. annia FI <br /> ❑ ❑ 12/Larvae ® ys <br /> r7� <br /> ❑ ❑ A. Pupae <br /> ❑ ❑ Z14. Adult <br /> ❑ ❑ 15. Light Population "- ,.p yr <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure o ation FeedingMater <br /> ❑ ❑ 18. Water Troughs A <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Structu Operation Houses <br /> ❑ 4Cleanina <br /> y^ ®Yr <br /> ❑ Walls/Ceilings s <br /> ❑ ❑ e uencStructure Opera �� "� -x" e <br /> ❑ ❑ 1. Well construction <br /> El El CUL 2. Connection <br /> Structure Operatio IOOr <br /> ro rl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable < �� <br /> El 6. Covin <br /> 1:1 El T-CLeaning Frequency <br /> Structure Opera nallS <br /> ❑ ❑ Smooth/Cleanable <br /> El El 9. Cl(!leaningFrequency <br /> Structure Operation Ca <br /> ❑ 40peration <br /> D. Condition <br /> itation <br /> Structure❑ Stora e <br /> El nsect/Vermin <br /> Structure mal Dis osal <br /> ❑ Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operatiorL ewage Disposal <br /> ❑ ❑ Se tic S stem <br /> ❑ ❑ 17. S <br /> Structure Operation ableS VacCinati0 RECEI (NSP C R <br /> ❑ ❑ . Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />