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oPqu�N•.o <br /> ,.•• .o � SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • .. -.N;P Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sjgov.org/ehd <br /> �/FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation r .� � °//® <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana eme OWNI RIOPERATOR { P ONE <br /> 1:1 ❑ 3. Spreading and Dis . g , ! l <br /> El ❑ 4. Concrete Tanks INSP CTION TYPEPROGRAM ELEMENT RECORD ID _ <br /> ❑ ❑ 5. Lagooning i <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dlspos <br /> ❑ ❑ 7. Burying h 2"of Cover <br /> ❑ ❑ 8. ApprovA Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation Vecto Control <br /> ❑ ❑ 10. omestic FI <br /> El 0 11. annia FI <br /> ❑ ❑ 1 . Larvae f <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population ` 1 <br /> ❑ ❑ 17. Heavy Population <br /> Structure Oper ion Feeding/water <br /> ❑ 18. Water Troughs r <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Structure Operation Houses volw <br /> ❑ JI ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ 23. Cleanin Fre uenc <br /> Structure Operation water Well <br /> ❑ ❑ 1. Well Construction <br /> Li F-1 2. Cross Connection <br /> Structure Operation Floors <br /> ID j 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin ° <br /> 7. CleaningFre uenc <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ ^ 10. Condition " <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ Eln JA 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies VaccinationRECEIVED BY INS E TOR <br /> n� <br /> 11 El18. Certificate on Premises y1ma I J/14 F',A-)-CA <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />