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,oAaug'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N X <br /> Y. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • a..- -- ;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> ffliffffifflogjIM DBA W INS T�IyON/ E <br /> Structure Operation aC <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection o2L" <br /> Structure Operation Manure Managemeod OWNERIOPERATOR PHONE p <br /> 11 ❑ 3. Spreading and Di ing / 17 <br /> VO <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPEPROGRAM ELEMENT RECORD ID <br /> ❑ [j5. Lagooning '® 'o - --� <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Bu in ith 2'of Cover ®® <br /> ❑ ❑ 8. Approid Concrete Tank , <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation VeCtqj Control <br /> ❑ ❑ 10. omestic FI <br /> El El 11. annia FI <br /> ❑ ❑ 1 . Larvae <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population - y� <br /> Structure O atlon FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls ® ' <br /> zo <br /> 20. Food Storage <br /> Operation Houses <br /> El21. FloorsEl22. Walls/Ceilin s El 23. Cleanin Fre uenc <br /> Structure Operation 0vater <br /> ❑ ❑ Well Construction <br /> C Connection <br /> Structure Operation !�fIod- <br /> 1:1 <br /> Properly Graded to Sewer <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation S� <br /> ❑ ❑ . Smooth/Cleanable ® �, <br /> ❑ ❑ 9. CleaningFrequency <br /> Structure Operation e <br /> ❑ ❑ . Condition <br /> El El nitation <br /> Structure Operatio 0 <br /> E] El2. Stora e <br /> 13. Inseot/Vermin <br /> Structure <br /> Op Lnimal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation a al <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 7. Sewtj,_ <br /> Structure Operation as Vaccine tio RECEIVI INSPECTOR <br /> ❑ 1 ❑ 8. Certificate w Premises <br /> VECTOR CONTROL INSPECTION FORM > <br /> EHD 40-06 4/6/12 Page ( Of <br />