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SAN JOAQUIN COUNTY . y ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street Stockton, CA 95202-3029 • c�4:.. ;. �r. Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd tlFOR VECTOR CONTROL INSPECTION FORM DBAM� INSPEC 1 N TE Structure Operation vv 1 ❑ ❑ 1. Well Construction PREMISE ADDRES RE-INSPEdTIO14 DATE ❑ ❑ 2. Cross-connection Structure Operation Manure Management OWNER/OPERATOR P ONE M'4 13 [33. Spreading and Disking ❑ ❑ 4. Concrete Tanks lyqECTION TYPE PROGRAM ELEMENT RECORD ID ❑ ❑ 5. Lagooning fd- q45 ❑ ❑ 6. Composting The items low represent code violations and must be corrected: Structure Operation Bird Disposal ® , , ❑ ❑ 7. Burying with 2"of over Ip y v 5 ❑ ❑ 8. Approved Concrete Tank ❑ ❑ 9. Removal from Premises 1 Structure Operation Vector Control , ❑ ❑ 10. Domestic FI v 11. Fannia FI ❑ ❑ 12. Larvae ❑ ❑ 13. Pupae ❑ ❑ 14. Adult t ❑ ❑ 15. Light Population ❑ ❑ 16. Moderate Population ❑ ❑ 17. Heavy Population Structure Operation Feeding/Water 1, ❑ ❑ 18. Water Troughs ❑ ❑ 19. Cups or Bowls r ''j anjd 20. Food Storage Structure Operation Houses ❑ ❑ 21. Floors ❑ ❑ 22. Walls/Ceilings �. ❑ ❑ 23. Cleanin Fre uenc r rr� Structure Operation Water Well ❑ ❑ 1. Well Construction L 2. Cross Connection Structure Operation Floors I (� ❑ ❑ 3. Properly Graded to Sewer ❑ ❑ 4. DrainA'kSt- S Nc ❑ N 5. Smooth/Cleanable6. Covin 1 (� ja7. Cleanin Fre uencSWcture Walls ❑ 8. Smooth/Cleanable❑ 9. Cleaning Frequency Structure Operation Cages ❑ ❑ 10. Condition 11. Sanitation Structure Operation Food ❑ ❑ 12. Storage 11 0 13. Insect/Vermin Structure Operation Animal Disposal ❑ ❑ 14. Removal from Premises ❑ ❑ 15. Other Structure Operation Sewage Disposal ❑ ❑ 16. Septic System ❑ ❑ 17. Sewer Structure operation Rabies Vaccination RECEIV O BY INSP T ❑ ❑ 18. Certificate on Premises VECTOR CONTROL INSPECTION FORM EHD 40-06 12/04/08 Page of