Laserfiche WebLink
AgU1N SAN JOACOUNTY <br /> �O .C�G ._ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N <br /> 1868 East Hazelton Avenue, <br /> Stockton, California 95205-6232 <br /> q.. ;...;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFORN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC ION D TE <br /> Structure Operation f ® ' /7 �� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection /,0/ eFf <br /> Structure Operation Manure Management/ OWNER/OPERATOR PJ ONE <br /> El [:13. Spreading and Diski g �� / `%) 3 Ole 7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 0 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispose <br /> ❑ ❑ 7. Bu in wit 2°of Cover ®A <br /> ❑ ❑ 8. Approve4concrete Tank <br /> ❑ ❑ 9. Remov from Premises <br /> Structure Operation Vector ontrol <br /> ❑ ❑ 10. D mestic FI <br /> 11. annia FI <br /> ❑ ❑ 12/Larvae 74, <br /> ❑ ❑ 16. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure 0 ration Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct Operation Houses <br /> I EA ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> .e / /" <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> El 2. Cross Connection r <br /> Structure Operation Floors <br /> El 0­6 3. Properly Graded to Sewer <br /> ❑ ❑ T 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ WIF 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El 1. Sanitation <br /> Structure Operation Food <br /> ❑ 1 12. Storage <br /> 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 9 14. Removal from Premises <br /> ❑ ❑ 0 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 6. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation abies Vaccination RECEIVED B t INSPECTOR <br /> ❑ ❑ Ckl& Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />