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�RA •�o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> Y. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> tea.. ;•NSP Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAINSPECT N DATE <br /> Structure Operation ` t f <br /> ❑ ❑ 1. Well ConstructionPREMISE ADDRESS RE-INSPECTION DATE <br /> 11 [32. Cross-Connection �,a Ja/ ^ <br /> Structure Operation Manure Management Ow/NE�R/OPERATORP�tONE <br /> ❑ ❑ 3. Spreading and Dis g (.:, t 2e.,�F/ 42 7-®SIF <br /> ❑ ❑ 4. Concrete Tanks INSPE ION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 01/6- <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Bu in th 2°of Cover ®� <br /> ❑ ❑ 8. A rov d Concrete Tank OOP <br /> ❑ ❑ 9. Rem val from Premises 4 <br /> Structure Operation vectgf Control IF IL/ <br /> ❑ ❑ 10.y6oniestic FI <br /> El n 1 Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure eration Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ j ❑ 19. Cups or Bowls <br /> El El 20. Food Storage <br /> Struct Operation I Houses <br /> ❑ 21. Floors r <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure OperatiotV, <br /> ❑ ❑ PiLl. Well Construction <br /> El ss Connection <br /> Structure Operation FIO <br /> ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable / H ^(g ^� <br /> El El 6. Covin <br /> 7. Frequency <br /> Structure Operatio IIS <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Ca <br /> ❑ ❑ 0. Condition <br /> _11--Santation <br /> Structure Operati FOO <br /> ❑ ❑ 12. Stora e <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑At 1 Removal from Premises <br /> ❑ ❑ 1 <br /> Structure Operation Sewage Dispos <br /> ❑ ❑QZ 16. a tic System <br /> ❑ ❑ 17. <br /> Structure Operat Rabies Vaccinate EI Y @ INSPECTOR <br /> ❑ ❑ 18. ertificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page of <br />