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SAN JOAQUIN COUNTY `�► <br /> �' •�2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> :a <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �lFOt3 <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA �' _ INSPECTION DATE <br /> Structure Operation i -71,2y// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana eme OWER/OPERATOR V PHONE e <br /> El ❑ 3. Spreading and Dis ng < < <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El [:] 5. Lagooning V4'S 1 pS-40_0 <br /> /V <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. BurvinqAh 2°of Cover <br /> ❑ ❑ 8. Appro d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> 2.70 elle- <br /> Structure Operation Vect r Control t° <br /> ❑ ❑ 10.homestic FI <br /> 1 Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population s <br /> ❑ 16. Moderate Populationfe <br /> El17. Heavy Population <br /> Structure Aeration Feeding/Water <br /> ❑ ❑ 18. Water Troughs r <br /> ❑ ❑ 19. Cups or Bowls <br /> jgc <br /> 20. Food Storage <br /> Struct a Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Weil Construction <br /> 2. Cross Connection <br /> Structure Operation Floors - <br /> El 113. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable _ <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition dam° -� <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ 0 12. Storage <br /> 13. insect/Vermin <br /> Structure Operation I Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ V 1 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ On 16. Se tic System <br /> ❑ ❑ 17. Sewer <br /> Structure OperationRabies Vaccination RECEIV Y INSP R <br /> ❑ ❑ 18. Certificate on Premises o ^� <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />