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I <br /> SAN JOAQUIN COUNTY 0 <br /> �� c2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> F. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • aq.. ;P Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> �Ii Oo <br /> VECTOR CONTROL INSPECTION FORM <br /> fir` I DBA INSPECTION DATE <br /> Structure Operation �' 1 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-connection <br /> Structure Operation Manure management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking tk-t- Z <br /> ❑ ❑ 4. Concrete Tanks INSP CTION YPE PROGRAM ELEMENT RECORDID <br /> El E] 5. Lagooning 4Y c�- <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises fin Jr-11 el A IN <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> El 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult . <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water �5 <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls , <br /> El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors rn® <br /> 1:1 El 22. Walls/Ceilings '� Y�i/N 1 <br /> ❑ I ❑ 23 Cleanina Fre uenc <br /> wtiE�' �a " °2 0 <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction $NYl <br /> El 2. Cross Connection <br /> Structure Operation Floors y <br /> ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain 4W 0L \ <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> El ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Fre uenc <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition w� <br /> ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. storage JJ�� <br /> ❑ 13. Insect/Vermin y� <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises � t✓' <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPE R <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> PageOf <br />