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r <br /> oe�a"l" SAN JOAQUIN COUNTY <br /> �:•�E�-.off <br /> rtb, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> c� ;- ;P• Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> D8 INSIDE ION TE <br /> Structure Operation Wat r Wijid <br /> ❑ ❑ 1. Well Construcfion PRq;�� <br /> REIN PECT N DATE <br /> 13 2. Cross-Connection <br /> Structure Operation Manure Management OWNE69OPERATOR PHONE <br /> 171 EI ..r 3. Spreading and Disking ` a <br /> ❑ ❑ 4. Concrete Tanks 1 CTtO T�'PE PRO RAM Et EMENT RECORD ID <br /> ❑ ❑ 5. Lagooning t4 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Aporoved Concrete Tank �` vU <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI (� <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae 094 <br /> ❑ ❑ 13. Pupae i Fr �- <br /> 11 ❑ 14. Adult • r�� GPV `r e;> 1,/,j <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population W w <br /> Structure Operation Feeding/Water j <br /> Cl E] 18. water Troughs y <br /> E] El19. cups or Bowls AN { <br /> 1-1 El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. WaIWCeilin s <br /> ❑ ❑ 23. Cleaning Fre uenc 1441M« <br /> .. w <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> i <br /> ❑ 6. Coving cLA-A- <br /> El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable nn <br /> ❑ ❑ 9. Cleanin Fro uenc <br /> f� u <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> structure Operation Food -Aevan, So <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure operation Animal Dis osai <br /> 4o --z �..+ <br /> ❑ 1:114. Remavai from Premises <br /> ` <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal ' <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY z CTOR <br /> ❑ ❑ 18. Certificate on Premises �r <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04108 <br /> Page I of]� <br />