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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 01 xr <br /> F. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • �q., 4:N�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �lFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC ION DIE <br /> Structure Operation 6 4 7 /0//Y <br /> ❑ ❑ 1. Well Construction PREMISE AbDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection erg a2 7 <br /> Structure Operation Manure Mana eme t 0WNER/0PERATQR P ONE <br /> ❑ ❑ 3. Spreading and Di ing o ®® <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 0571rS- <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispcAai <br /> ❑ ❑ 7. Bu in with 2°of Cover �^ �f <br /> ❑ ❑ 8. Apprived Concrete Tank <br /> ❑ ❑ 9. R oval from Premises r o <br /> Structure Operation Ve9for Control <br /> ❑ ❑ Id Domestic FI <br /> El El 1. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ a 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Aeration Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls ®� <br /> 20. Food Storage <br /> Struc re Operation Houses <br /> ❑ 21. Floors d <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Structure Operatio stet W r� <br /> ❑ ❑ . Well Construction J 1 <br /> Connection <br /> Structure Operatio Floor <br /> ro d Graded to sewer <br /> ❑ ❑ 4. Drain <br /> ❑ I ❑ 5. Smooth/Cleanable <br /> 6. Covin ` <br /> 7. Cleanin Fre uen <br /> Structure Operation ells <br /> ❑ ❑ mooth/Cleanable <br /> ❑ ❑ ning Frequency <br /> Structure Operation Cag!' <br /> ❑ ❑ Condition <br /> 11 itation <br /> Structure Operation <br /> El 11 Stora e <br /> Inse rmin <br /> Structure Operatio nlmal Disposal <br /> ❑ ❑ move tom Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation ewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑10 <br /> RStructure Opeabies Vaccination INSPECOR <br /> ❑ <br /> 18. Certificate on Premises F <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page-'L of <br />