Laserfiche WebLink
Aa"`" SAN JOAQUIN COUNTY 10 <br /> 2 � y ENVIRONMENTAL HEALTH DEPARTMENT <br /> F. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • �q.. :;..•;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> LIFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTI N D TE <br /> Structure Operation Water Well A-3 <br /> ❑ ❑ 1. Well ConstructionPREMISE ADDRESS RE-INSPECTION DATE <br /> El El 2. Cross-Connection4 �7.3 <br /> Structure Operation Manure Mana eme t OW R/OPERATOR PHONE <br /> ❑ E] 3. Spreading and Di ing t� ) 7�7- ,31 <br /> El E] 4. Concrete Tanks INSP CTION TYPEPRO RAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 415-41 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Bu in ith 2°of Cover <br /> ❑ ❑ 8. Approy6d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation vect Control <br /> ❑ ❑ 10.A.mestic FI <br /> _111 Fannia FI <br /> ❑ ❑ . Larvae r <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ Y 14. Adult <br /> ❑ ❑ 15. Light Population 4 pie <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure O ration FeedinglWater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> El El 20. Food Storage <br /> Struct a Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings ® f <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation at I <br /> ❑ ❑ 1. Well Construction7 <br /> , n <br /> 2. Cross Connection <br /> Structure Operation OOPS <br /> El El <br /> ro d Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation W <br /> ❑ ❑ mooth/Cleanable <br /> ❑ ❑ 9. ing Fre uenc <br /> Structure Operation Ca eS <br /> ❑ ❑ 10. Condition LO <br /> 11. Sanitation <br /> Structure Operatio FoR9 <br /> 1:1 1- . Stora e <br /> 3. In <br /> Structure Operatio nimal DIS O <br /> ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation ewage Dis <br /> ❑ ❑ Y16. Se tic System <br /> ❑ ❑ 17. S <br /> Structure Operatio Rabies Vaccination R V Y ? INSPECTOR <br /> ❑ ❑ 18. e n remises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />