Laserfiche WebLink
r <br /> 'oPcxu�nr,,.co SAN JOAQUIN ®LINTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • q. ,;:,..;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �IPORI� p® ®TR L® p® <br /> VECTOR CONINSPECTION FORM <br /> MMESMS DBAS10INSPE^C�TI N DATE <br /> Structure Operation �?n� r ® -? <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection-_/_ .23 9 (/ <br /> Structure Operation Manure Managennevft OWNS OPERATOR P ONE <br /> 1:1 El 3. Spreading and Di ing l) 'q /f <br /> ❑ ❑ 4. Concrete Tanks/ IN CTION TYPEPROGRAM ELEMENT RECORD ID <br /> El 5. Lagooning �-� <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. Bu in with 2'of Cover <br /> ❑ ❑ 8. Apprplved Concrete Tank <br /> a <br /> ❑ ❑ 9. R oval from Premises <br /> Structure Operation Ve or control <br /> ❑ ❑ 1 . Domestic FI <br /> Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population / <br /> Structure ration Feeding/Water !' ' <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls s A <br /> 20. Food Storage <br /> Struc re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings C <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> RMWEREMMMEM <br /> Structure Operation water well <br /> ❑ ❑ 1. Well Construction / <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> 3. Pro erl Graded to Sewer <br /> ❑ ❑ L4 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> Ej El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanabie <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation ages <br /> ❑ ❑ Condition <br /> 11. Sanitation <br /> Structure Operation Ood <br /> ❑ ❑ 12. storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 5. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operatio Rabies Vaccination R IVSD BY INS CTOR m <br /> 1� <br /> ❑ ❑ 8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />