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SAW JOAQUIN COUNTY <br /> R <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> �lFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA ee <br /> P INSPECTION DATE <br /> Structure Operation P' / <br /> ❑ ❑ 1. Well Construction PREMItS�E ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3 ! z5 ®7 <br /> Structure Operation Manure Mana eme t OWNS OPERATOR PHONE <br /> ❑ ❑ 1 3. Spreading and DiKing r' )ws- V <br /> ❑ ❑ 4. Concrete Tank INSPECTION PEPROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 17 10k 0V 000x'y <br /> ❑ ❑ 6. compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo al <br /> ❑ ❑ 7. Bu in ith 2°of Cover <br /> ❑ ❑ 8. A ro d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises ® ,p <br /> StructureOperation veC$ r control <br /> ❑ ❑ 10. omestic FI <br /> 1:1 El 1 X. Fannia FI <br /> ❑ ❑ 2. Larvae <br /> d&' f °� <br /> ❑ ❑ Y 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Po ulation f r <br /> 40 <br /> ❑ a 16. Moderate Population p <br /> ❑ 17. Heavy Population <br /> Structure ration FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Stora e <br /> Struc re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cieanin Fre uenc ,o <br /> Structure Operation ater <br /> ❑ [] le) - <br /> . Well Construction <br /> 1:1 El Connection <br /> Structure Operation FI <br /> Properly Graded to Sewer <br /> ❑ ❑ Drain ` <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 11 6. Covin <br /> El 7aning Frequency <br /> StructureOperation N/a .– <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ . Cleaning Frequency <br /> Structure Operation a eS <br /> ❑ ❑El 10. Condition 411 0 9 <br /> 1 itation <br /> Structure operation F <br /> ❑ ❑ Storage <br /> El El 13. Insect/Vermin <br /> Structure Operation –Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation Sewage Disposa <br /> ❑ ❑ is ystem <br /> ❑ ❑ 7. Sewer <br /> Structure OperationIeS vaccination REC BY INSPd O <br /> ❑ ❑ i icate on Premises 'T <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />