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SAN JOAQUIN COUNTY <br /> P <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:WWw.sjgov.org/ehd <br /> L�FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTI N DATE <br /> Structure Operation -7 '/r// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRE�SS/ RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNEFJOPERATOR P ONE <br /> ❑ ❑ 3. Spreading and Dis ' g i 9 '.0e <br /> r� <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 0:5--A 7 0 3s- <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispospi <br /> ❑ ❑ 7. Bu in h 2"of Cover <br /> J> <br /> ❑ ❑ 8. Approv,06 Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation vecto Control <br /> ❑ ❑ 10. Amestic FI <br /> El El 11. annia Fly 7 <br /> ❑ ❑ 1 . Larvae <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. HeavyPopulation <br /> Structure ration Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage 4_ <br /> Structyfe Operation I Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> El 3. Properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable s fPn <br /> El El 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleanin Fre uenc <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 3. 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 RECEIV INSP T R <br /> ❑ ❑ 8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />