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SAN JOAQUIN COUNTY <br /> %oO. E.COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q.. :.a;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> IniffiffifflifflM DBA INSPECTION DATE <br /> Structure <br /> Structure O eration 7 /`I <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure management OWN R/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disk/ng j� Q �, -A'-,-� 9 rg- <br /> ❑ ❑ 4. Concrete Tanks INSPE TION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning r-f 4IV6-1f 05.2 7 0.3 !" <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Burying wA 2°of Cover ' <br /> ❑ ❑ 8. ApproviConcrete Tank <br /> ❑ ❑ 9. RemoV41 from Premises + <br /> Structure Operation Vector ontrol <br /> ❑ ❑ 10. amestic FI <br /> 11. jannia Fly <br /> 11 ❑ 1 Larvae <br /> ❑ ❑ 39. Pupae <br /> ❑ ❑ A 4. Adult <br /> ❑ ❑ j 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure Ope tion Feeding/Water <br /> ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structur Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ 23. Cleanin Fre uen <br /> Structure Operation ate <br /> ❑ ❑ Well Construction <br /> El El ss Connection <br /> Structure OperationF s�`t <br /> Properly Graded to Sewer <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El 7--Gipaning Frequency <br /> Structure Operation e Wa <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9._gWaning Frequency <br /> Structure Operation C205 <br /> ❑ ❑ . Condition o <br /> El El Y nitation <br /> Structure OperationFogje <br /> El 112. Stora e <br /> El F-11 Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ . Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. <br /> Structure operatio Rabies Vaccinati REC ED INSPE TO <br /> ❑ 1 EXt78. Certificate on Premises21 <br /> VECTOR CONTROL IN PECTI N FORM <br /> EHD 40-06 4/6/12 <br /> Page of�, <br />