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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> u1 x <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •., :P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> RG%FORIt p� ® p� p� <br /> VECTOR CONTROL INSPECTION FORM <br /> rDB INSPECTIO DATE <br /> Structure Operation 1,11 <br /> ❑ ❑ 1. Well Construction IS ADDRESS RE-INSPECTION DATE <br /> 2. Cross-Connection - 7Structure Operation Manure Mana eme E OPERATOR P ONE <br /> 3. Spreading and Dis ng ,", 4�50.9 3 -I j❑ ❑ 4. Concrete Tanks SPEC 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 DISPOS I <br /> ❑ ❑ 7. Bu in th 2"of Cover J <br /> ❑ ❑ 8. Approyj1d Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises v <br /> Structure Operation Vect Control <br /> ❑ ❑ 10.komestic FI <br /> __III Fannia FI <br /> ❑ ❑ . Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ Y, 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Strutt a Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> a <br /> ❑ ❑ 23. Cleanin Fre ..ncj. <br /> Structure Operatio Water <br /> ❑ ❑ 1. Well Construction ^ <br /> 2. Cross Connection <br /> Structure Operation s <br /> -3-15-roperly Graded to Sewer <br /> ❑ ❑ 4. Drain oe ee <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 1:1 7. Cleaning Frequency <br /> Structure Operation 2a <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency ° <br /> Structure Operation age <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operatio OOd <br /> ❑ ❑ 12. Storage <br /> El 13. Insect/Vermin <br /> Structure Operation ntmal Di <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation Sewage Dis <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 7. Sewer <br /> Structure Operation S VaCClnatio RECEIV D Y INSPE TO <br /> ❑ 8. Certificate on Premises r; <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> -_- Page , of <br />