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°aur" SAN J 1 COUNTY <br /> 'o ,. ........co <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> ca •.. :: �;;� Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR p� p� p� <br /> VECTOR CONT INSPECTION FORM <br /> FDDBA INS TION ATE <br /> Structure Operation �/ /T744 <br /> ❑ ❑ 1. Well Construction EMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 6 6-� , <br /> Structure Operation Manure Mana eme ER/OPERATOR M 'g6 <br /> ❑ ❑ 3. Spreading and Di ingS-/& <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 1:1 E] 5. Lagooning <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. ApprmAd Concrete Tank <br /> ❑ ❑ 1 9. Re val from Premises <br /> Structure Operation VECt Control d6 C-11.10-114" <br /> ❑ ❑ 10. omestic FI <br /> El El1 Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupaet1 <br /> El El14. AdultIt <br /> Ae <br /> ❑ ❑ 15. Li ht Population <br /> ❑ Ej 16. Moderate Population l <br /> ❑ 17. Heavy Population <br /> Structure ration Feeding/Water 'y <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct a Operation Houses l �/ e <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> /' <br /> Structure Operation water <br /> ❑ ❑ 1. Well Construction lr-e /2 <br /> 2. Cross Connection <br /> Structure Operatio Floor <br /> 3. Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain a44 Ile <br /> r <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ Ej 6. Covin <br /> El 7. Cleaning Frequency <br /> �. <br /> Structure Operation waliS <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operati.n7 Cageoes <br /> ❑ ❑ ondition <br /> El itation <br /> Structure �Operajtlono❑ tora e <br /> Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ . 0 Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination LRENSP( TOR <br /> El 1118. Certificate on Premises 4, <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> .� Page of <br />