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�°�aul7 co SAN JOAQUIN COUNTY 16 <br /> 2 `2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> .a <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • dq.. .::,.•�P• Telephone:(209)468 <br /> OR -3420 Fax:(209)464-0138 Web:WWW.sjgov.org/ehd <br /> /PN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTIODATE <br /> Structure Operation ® t/ <br /> ❑ ❑ 1. Weil Construction PREMISE DDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection -Z 3.2 a 7 j67, <br /> Structure Operation Manure Mana eme OWNE OPERATOR PHONE <br /> 1:1 ❑ 3. Spreading and Dis ng le`s"+ �' <br /> ❑ ❑ 4. Concrete Tanks INS CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning / <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DIspO l <br /> ❑ ❑ 7. Bu in ith 2°of Cover <br /> ❑ ❑ 1 8. Approy6d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10. omestic FI <br /> 14. Fannia FI j <br /> ❑ ❑ 2. Larvae / 1 <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure 0 ration Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Z <br /> Operation Houses <br /> ❑ 21. Floors❑ 22. Walls/Ceilin s <br /> ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ onstruction <br /> 2 s Connection <br /> Structure Operatio FI <br /> 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> .7�ing Frequency <br /> Structure Operation Wal <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. CI!Qning Frequency <br /> Structure Operation -1C ge <br /> ❑ ❑ 0. Condition <br /> nitation <br /> Structure Operatio p <br /> ❑ ❑ 12. Storage <br /> El Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 4 emoval from Premises <br /> E] ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ ewer <br /> Structure Operation R C VE Y INS C OR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page/of <br />