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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> q.., ;..•;e Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��FORd CON <br /> VECTOR CONT INSPECTION FORM <br /> DBA INSPECTION D 1 E <br /> Structure Operation "7 /® <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 1:1 El 2. Cross-Connection > / <br /> -3 <br /> Structure Operation Manure Managemetit OWNEEVOPERATOR P ONE <br /> ❑ 1 ❑ 3. Spreading and Di- ing a� '- ) 9 7 3 y <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID i <br /> 11 E] 5. Lagooning c-C,'1 d? Q 6-3 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispopfil <br /> ❑ ❑ 7. Burvinqith 2°of Cover <br /> ❑ ❑ 8. Approk Concrete Tank <br /> ❑ ❑ 9. Reny6val from Premises <br /> Structure Operation Vectir Control <br /> ❑ I ❑ 10. omestic FI <br /> _14 Fannia FI <br /> ❑ ❑ 2. Larvae 3 <br /> ❑ ❑ Y 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ EY 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure station Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls r r <br /> 20. Food Storage <br /> structuyll Operation Houses <br /> ❑ 21. Floors <br /> 22. Walls/Ceilings <br /> 4Structure4O <br /> 23. Cleanin Fre uencation er H/ <br /> ❑ ❑ onstruction <br /> El -2-49fess- <br /> onnection <br /> Structure Operati n FIO <br /> o erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El �: nq Frequency <br /> Structure Operati w <br /> ❑ ❑ A. smooth/Cleanabie <br /> ❑ ❑ V(!��aning Frequency <br /> Structure Operati n CaggS <br /> ❑ ❑ 10. Condition �d <br /> El nitation <br /> StructureOperatio <br /> ❑ ❑ tors e <br /> El 13. Insect/Vermin <br /> Structure Operation imal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operat n Sewage Dis O <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ <br /> Structure Ope .on Rabies Vaccination... R IVED INSET r <br /> Eln remises e <br /> VECTOR CONTROL INSSCTION FORM t <br /> EHD 40-06 4/6/12 Page J Of 1 <br />