The Sacramento and Yolo Mosquito and Vector Control District (SYMVCD, also referred to as “the District”) conducts surveillance and management of mosquitoes in Sacramento and Yolo counties in California. Following an increase in numbers and West Nile virus (WNV) infection rates of Culex tarsalis and Culex pipiens, the District decided on July 26, 2007, to conduct aerial applications of Evergreen® EC 60-6 (60% pyrethrins: 6% piperonyl butoxide) over approximately 215 km² in the north area of Sacramento County on the nights of July 30, July 31, and August 1, 2007. At the same time, the District received notification of the first human WNV case in the area. To evaluate the efficacy of the applications in decreasing mosquito abundance and infection rates, we conducted pre- and post-trapping inside and outside the spray zone and assessed human health risks from exposure to the insecticide applications. Results showed a significant decrease in abundance of both Cx. tarsalis and Cx. pipiens, and in the minimum infection rate of Cx. tarsalis. Human-health risks from exposure to the insecticide were below thresholds set by the US Environmental Protection Agency.