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SIN 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 /> �s p® ® �p p� <br /> VECTOR CONTROL INSPECTION FORM <br /> 7DBA INSPECTION DAT <br /> Structure Operation 7/. -7 <br /> ❑ ❑ 1. Well construction DRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection Structure Operation Manure Mana emen RATOR P NE <br /> ❑ ❑ 3. Spreading and Dis ' g <br /> El [j4. Concrete Tanks INSPE TION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning J d 2 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos I <br /> ❑ ❑ 7. Bu in th 2°of Cover <br /> ❑ ❑ 8. A rov d Concrete Tank <br /> ❑ ❑ 9. Rem val from Premises e <br /> Structure Operation Vect Control <br /> ❑ ❑ 10: omestic FI <br /> El I El 1 X Fannia FI <br /> ❑ ❑ . Larvae �~ <br /> ❑ ❑ 113. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population 2-re- <br /> El <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure jdAeration Feeding/Water <br /> ❑ Y ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls eo <br /> 20. Food Storage <br /> Stru ure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s ""` ex <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> TStructure <br /> Operation Water well <br /> ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Operation Floors <br /> El 3. Property Graded to Sewer <br /> 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> 6. Covin 7. Cleanin Fre uenc Operation walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition p `� <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. insecUVermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 1,, 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation 1 Sewage Disposal' <br /> ❑ ❑ 16. Se tic S stem <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RE IV BY INSPE TO <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 0 �/ X/ <br /> Page C of <br />