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SAN JOAOUIN COUNTY <br /> �pP •.,p0 <br /> 2•' r-rr-, 'Z <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> ::,��P Telephone:(209)468-3420 <br /> OR Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �a p� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Well dl.2. /,'_ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-connection $Ve l° o X'..E <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ' g e!d S"`_ .2 V <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 4,4, C�" �( <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Bu in h 2"of Cover <br /> ❑ ❑ 8. ApprovQ6 Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises " <br /> Structure Operation Vec4 Control <br /> ❑ ❑ 10.Jifom.stic FI <br /> 11 Fannia FI <br /> ❑ ❑ A. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ Q, 16. Moderate Population ' <br /> ❑ 17. Heavy Population �r <br /> Structure ration Feeding/Water <br /> El ❑ 18. Water Troughs <br /> ❑ ❑ 19. cups or Bowls <br /> 20. Food Storage <br /> Struct a Operation Houses <br /> ❑ 21. Floors I ® ✓'f <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> 7MOMMEMEMM <br /> - <br /> C <br /> Operation Water Well <br /> ❑ 1. Well Construction S 'El I El 2. Cross Connection <br /> Operation I Floors , <br /> rl <br /> 13 1 3. Properly Graded to Sewer <br /> ❑ ❑ . Drain !� 's2 <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency Al. ` <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 13 E] 1. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 3. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ rVW 6. Septic System <br /> ❑ . Sewer <br /> Structure �OPB <br /> ion abieS Vaccination E IVED BY, INSPE TOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />