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SAN JOAQUIN COUNTY <br /> z � ENVIRONMENTAL HEALTH DEPARTMENT <br /> An <br /> F. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �a..• :.N;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOK <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation F a8 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection / Wr Z <br /> Structure Operation Manure Managemepit OWNERIOPERATOR PHONE <br /> ❑ I ❑ 3. Spreading and D4 <br /> ing -_f '7).S d�1 - 3 y 72 <br /> ❑ ❑ 4. Concrete Tank INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning tP <br /> ❑ ❑ 6. Compostin9l The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. Bu i with 2"of Cover r E'er <br /> ❑ ❑ 8. Appj&ed Concrete Tank <br /> ❑ ❑ 9. moval from Premises <br /> Structure Operation V for Control <br /> ❑ ❑ . Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae ✓L- <br /> ❑ ❑ 13. Pupae <br /> ❑ EV 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> Fy 20. Food Stora e <br /> Stru lure Operation Houses <br /> ❑ 21. Floors �. <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Sam <br /> StructureOperation Water Well - , 'h <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 IF <br /> 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operation WallS <br /> ❑ ❑ NA 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 /> ❑ ❑ 14. Removal from Premises <br /> El 5. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 1 . Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPECTO <br /> ❑ 10-118. Certificate on Premises ' <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of_( <br />