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PQuiN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL_ HEALTH DEPARTMENT <br /> Ur <br /> F. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • q.. :...;p Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> G/FC) <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAINSPECTION DATE <br /> Structure Operation 7d, <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection-/_ Ge 41' Av or,$ <br /> Structure Operation Manure Mana eme OR/OPERATOR PkIONE <br /> 1:1 ❑ 3. Spreading and Dis ' g w E'ee-' ' - -✓ 1/12--_7 fl/ Jos= ®7 tvlo <br /> ❑ ❑ 4. Concrete Tanks INSPJkCTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 4,040' w 'P12- <br /> 11 <br /> P❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Bu in h 2"of Cover <br /> ❑ ❑ 8. ApproVA Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation vecf Control <br /> ❑ ❑ 10. Aomestic FI <br /> 11 Fannia FI <br /> 1:1 EI1 . Larvae `� sZ <br /> ❑ ❑ 3. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 11 17. Heavy Population <br /> Structure O ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs _ <br /> ❑ ❑ 19. Cups or Bowls .-- <br /> 20. Food Storage <br /> Structu Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Structure Operation Water Well <br /> ❑ qV4. <br /> Well Construction <br /> Cross Connection <br /> Structure Ooors <br /> 13 F1 Properly Graded to Sewer <br /> ❑ Drain <br /> ❑ Smooth/Cleanable n n� <br /> 6. Covin <br /> 11 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages _ <br /> ❑ ❑ 10. Condition <br /> El 1-1 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 D 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination R INP R <br /> El El18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />