Laserfiche WebLink
SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y t 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •�q.. M ;� " Telephone:(209)468-3420 Fax:(209) 464-0138 Web:wwwsjgov.org/ehd <br /> ��FORN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECT ON D TE <br /> Structure Operation / ®� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 1:1 El 2. Cross-Connection -?Y.71 r <br /> Structure Operation Manure Mana erne t Ow= <br /> PHONE <br /> 1:1 El3. Spreading and Di ing + l /11?o—3 7� <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 44V-4 1 1 0-Y 00ae,0 <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispO I <br /> ❑ ❑ 1 7. Bu in ith 2"of Cover lea" 4z <br /> ❑ ❑ 8. ApprovA Concrete Tank Ell <br /> ❑ ❑ 9. Rem all from Premises ' <br /> Structure operation Vect Control <br /> ❑ ❑ 10. omestic FI <br /> 11 El 11 Fannia FI <br /> ❑ ❑ it Larvae <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population -14 <br /> ❑ Ey 17. Heavy Population <br /> Structure Ope tion Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Structure4 Operation Houses <br /> ❑ ❑ 21. Floors yj <br /> ❑ 22. Walls/Ceilings <br /> I Al ❑ 1 23. Cleaning Frequency <br /> Structure Operation ater e <br /> ❑ ❑ ell Construction <br /> Connection �— <br /> Structure Operation Floors <br /> El roperly Graded to Sewer <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9.,QIL <br /> ning Frequency <br /> Structure OperatiorK Cages <br /> ❑ ❑ Condition <br /> nitation <br /> Structure Operati P3. <br /> 1:1 Elrage <br /> ectiVermin <br /> Structure operation -Animal Disposal <br /> ❑ ❑ 1 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure operatic sewage D al <br /> ❑ ESe tic System <br /> ❑ ❑ 17. <br /> Structure Operetta, Rabies Vaccination RECEIVED BY INSP O <br /> "9 <br /> ❑ 1 ❑ VJAJ,Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page of <br />