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SAN JOAQUIN COUNTY • <br /> P <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /> ��FORt� <br /> VECTOR CONTROL INSPECTION FORM <br /> kW DBAo j INSPE TION ATE <br /> Structure Operation 1 "'A J _ i <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS y KE-IN PEC ION DATE <br /> ❑ ❑ 2. Cross-Connection �ti �vt <br /> Structure Operation Manure Mana ement OWNS PE TOR PHONE <br /> El 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning L:.'..-Vl (Aja(-t- jP4Z <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal /� �� <br /> 1:1 El 7. Burying with 2"of Cover W I G4 <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises1 <br /> - 2 C C <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> ❑ 11. Fannia Fly � � <br /> 1:1 E-112. Larvae v 1:.�7f"' --i�,i t" <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fre gent <br /> a <br /> e <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin Ni" <br /> ❑ ❑ 7. Cleaning Frequency <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. insecWermin <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 RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises VECTOR CONTROL CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />