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i <br /> SAN JOAQUIN COUNTY <br /> 2 '-''r�r• -:Gi <br /> < ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •., ti ;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> '9G I F p Ftti <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPV7E� O D`p;TE <br /> Structure Operation 7 //S- <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 757/ . <br /> Structure Operation Manure Managemeeft OR/OPERATOR PHONE ® <br /> 1:1 ❑ 3. Spreading and Deng WN �. .%r I '( vh p ®- <br /> ❑ ❑ 4. Concrete Tank INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 11 E] 5. Lagooning yS �Y <br /> ❑ ❑ 6. Compostirid The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp sal <br /> ❑ ❑ 7. Burvidwith 2°of Cover <br /> ❑ ❑ 8. Ap ved Concrete Tank <br /> ❑ ❑ 9. moval from Premises <br /> Structure Operation V for Control <br /> ❑ A Domestic FI <br /> El 11. Fannia FI t,[ - <br /> ❑ ❑ A 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ 1:119. Cups or Bowls -- h j <br /> Ej 20. Food Storage <br /> st lure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fre gen <br /> Structure Operatio ate 1 <br /> ❑ ❑ Well Construction h `$ <br /> El C2. Cross Connection <br /> Structure Operation <br /> El roperly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El7 ning Frequency <br /> Structure Operation MY <br /> ❑ E] "' 0. Smooth/Cleanable <br /> El E] . Cleaning Frequency <br /> Structure Operation C <br /> ❑ ❑ 0. Condition <br /> 1. Sanitation <br /> Structure Operation <br /> ❑ ❑ tore e <br /> El Ej 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ . Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation abieS Vaccina o RECEIVED BY INSPECTOR <br /> El El L 8. Certificate on Premises <br /> �e <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of / <br />