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SAN JOAQUIN COUNTY <br /> CoA .moo <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> F. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •a�., ..-NSP Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �h9i <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION D � <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. cross-connection -57 <br /> Structure Operation Manure Mana em t OWNER/OPERATOR VHONE <br /> ❑ ❑ 3. Spreading and Di ing 1 �)3-7,3® 7C/' 7 <br /> ❑ ❑ 4. Concrete Tank INSPE TION TYPE PROGRAM ELEMENT REC RD ID <br /> ❑ ❑ 5. Lagooning 41 Sy 1 A900,0'aa,& <br /> ❑ ❑ 6. CompostinV The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp e) <br /> El El7. Bu in ith 2'of Cover ® M' <br /> ❑ ❑ 8. Appr ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation vecfor Control <br /> ❑ ❑ 19 Domestic FI <br /> El Fannia FI - / <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ EY 15. Li ht Po ulation eLtt, r <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure peration Feeding/Water <br /> ❑ ❑ 18. Water Troughs y7 lerz <br /> r� <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Stru ure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. cieanin Fre uenc <br /> NO <br /> AN <br /> StructureMEE] (10 <br /> ter MW A4A <br /> ❑ Well construction <br /> Connection <br /> Structure <br /> 11 El Properly Graded to Sewer <br /> ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 11 El 6. Covin <br /> 13 El I Z��ning Frequency <br /> Structure Operation ! <br /> ❑ ❑ s, . Smooth/Cleanable <br /> ❑ ❑ lv� a—GlWing Frequency <br /> Structure Operatio ca <br /> ❑ ❑ 0. Condition <br /> 1:1 El 1. anitation <br /> Structure Operation o0 <br /> ❑ 1:1, . Stora e <br /> 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ <br /> Structure Operati n Sewage Dis <br /> ❑ ❑ . Se tic S stem <br /> ❑ 17. S <br /> Structure operation abies Vaccinatlo REc By INs E To <br /> ❑ erti'ca�e on Premises i <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page 1 of <br />