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MAN... <br /> SAN JOAQUIN COUNTY <br /> xENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • •.: ;o • Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> 9�/FORM <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation e �� fY//-? <br /> ❑ ❑ 1. Well Construction PREMIS ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana eme t OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Di ing , �-."s� e- J /�?/ <br /> ❑ ❑ 4. Concrete Tanks INSPECTION PE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning S rf <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispogfil <br /> ❑ ❑ 7. Burvinq 1jith 2"of Cover ®" <br /> ❑ I ❑ 8. Appro4d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises > <br /> Structure Operation vecto Control <br /> ❑ ❑ 10.homestic FI <br /> 1:1 Lj 11 Fannia FI ®® <br /> ❑ ❑ A. Larvae el <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ EV 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure o ration Feeding/Water ' <br /> 11 ❑ 18. Water Trou hs <br /> El El 19. Cups or Bowls <br /> w20. Food Stora e A <br /> Structu Operation Houses l? tri h �+ <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cieanin Fre uenc <br /> Structure Operation Irater <br /> ❑ 1 ❑ . Well Construction ' e � <br /> El 2. Cr Connection <br /> Structure Operation oof <br /> —Pro]perly Graded to Sewer <br /> ❑ ❑ VAZL. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Clganing Frequency <br /> Structure Operation <br /> ❑ ❑ A,8. Smooth/Cleanable <br /> ❑ ❑ tw . gleaning Frequency <br /> Structure Operation ag <br /> ❑ El10. Condition , <br /> 1. anitation <br /> Structure Operation o0 <br /> ❑ ❑ 2. Storage <br /> EJ 13. Insect/Vermin <br /> Structure Operation IS os <br /> ❑ ]:::&_15. <br /> rom Premises <br /> El Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ Septic System <br /> ❑ ❑ r <br /> Structure Operation acct ti CEI E INSPECTOR <br /> ❑ ❑ ertificate on Premises ? <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page®of <br />