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PQUIN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q.:- . ... Telephone:(209) 468-3420 Fax:(209)464-0138 Web:Www.sjgov.org/ehd <br /> <<FORN p® �® <br /> VECTOR CONT INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Well 101C4. <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection f,9 <br /> Structure Operation Manure ManagemerA OWNERIOPERATOR P NE <br /> ❑ ❑ 3. Spreading and Dis g 1 3 - 7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning ' le y s-y <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispose <br /> ❑ ❑ 7. Bu in wi 2"of Cover aA <br /> ❑ ❑ 8. Approve Concrete Tank <br /> 0 <br /> ❑ ❑ 9. Removsf from Premises l ° <br /> Structure Operation vector Aontrol <br /> ❑ ❑ 10. DQ11n.stic FI <br /> 11. FAnnia FI <br /> El 1:112. Larvae <br /> ❑ ❑ it Pupae <br /> ❑ ❑ f4. Adult <br /> ❑ ❑ 15. Light Population �- <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Oper ion FeedingMi'ater <br /> ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls 6 v'7- 're- ✓ 0% <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings ' d':0 p,,eonee Cp ✓Y' <br /> ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ On 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors -e <br /> El 3. Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation WaIIS <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. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ Qk14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑0D 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation od Rabies vaccination RFZtt#ED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises XW44,I - <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page / of <br />