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SAN JOAQUIN COUNTY V;9. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> { <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> aq Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��PORN <br /> VECTOR CONTROL INSPECTION FORM <br /> FDDBA INSPE TION TE <br /> Structure <br /> Operation / <br /> ❑ ❑ 1. Well Construction EMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 7Structure Operation Manure Mana em t N OPER TOR PHONE <br /> 13 ❑ 3. Spreading and Di ing <br /> ' p^ " f <br /> [3 ❑ 4. Concrete Tank INSPE ION TYPE PROGRAM ELEMENT R CO DID <br /> 11 E] 5. Lagooning S` <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Buryinq Arith 2°of Cover ®p <br /> ❑ ❑ 1 8. Appr.V6d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises ® "� <br /> Structure Operation vect Control <br /> ❑ ❑ 10.homestic FI <br /> Lj _111 Fannia FI <br /> ❑ ❑ h. Larvae t <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ Y 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ EV 16. Moderate Population / ►� <br /> ❑ U1 17. Heavy Population <br /> Structure O tion Feeding/Water <br /> ❑ ❑ 18. Water Troughs '® <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structure/ Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> LL MORI" <br /> ❑ 23. Cleaning Fre en <br /> Structure Operatio Water <br /> ❑ ❑ Well Construction <br /> oss Connection _ <br /> Structure Operation FI ® /® <br /> '-3-15r-operly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 1:1 13 6. Covin <br /> ing Frequency <br /> Structure Operetlo Nf <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ Cleaning Frequency <br /> Structure Operation Ca <br /> ❑ ❑ 10. Condition <br /> El 1:1 anitation <br /> Structure Operation F92V,- <br /> ❑ ❑ . Stora e <br /> 13. Insect/Vermin <br /> Structure Operation —Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 1 <br /> Structure Operation <br /> ❑ ❑ gNA6. Septic System <br /> StructureOperati Rabies Vaccina • Y q �INSPEOTO <br /> 11 ❑ Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page f of <br />