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0�4"•" SAN JOAQUIN COUNTY If <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> w <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 /> ME DBA INSPECTION DATE <br /> Structure Operation Watgryftll Z,i// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWN OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking (Z L/Q <br /> ❑ ❑ 4. Concrete Tanks INSPEC N TYPE PROGRAM ELEMENT RECORD ID <br /> 11 0 5. Lagooning <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Bur)(ing with 2"of Cover O7C <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fly { * C <br /> El M 11. Fannia FI <br /> ❑ ❑ 12. Larvae �7 C <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population i <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction (` <br /> 2. Cross Connectio <br /> Structu operation Floors <br /> ❑ ❑ 3. Property Grad96 to Sewer <br /> ❑ ❑ 4. Drain ( I <br /> ❑ ❑ 5. Smooth/ eanable <br /> ❑ 6. Coving/ <br /> 7. Clean' gFrequency <br /> Structure Ope on WallsZ If <br /> ❑ ❑ 8. S ooth/Cleanable <br /> ❑ ❑ 9.kleaning Frequency is . <br /> Structure Operation ges <br /> 11 AO. Condition <br /> 1 Sanitation <br /> StructureOpera Fo d C` <br /> ❑ ❑ 12. storage <br /> 13. Ins ermin <br /> Structure Op tion Animal is oral <br /> ❑ ❑ 14. Remov from Premises <br /> ❑ ❑ 15. Other <br /> StructureOperation Sewage DisPliksal <br /> ❑ ❑ 16. Septic System ` <br /> ❑ 17. Sewer C ®r <br /> drre Operation Rabies Vaccinatio RECEIVED BY INS CTO <br /> ❑ ❑ 18. Certificate on Premise <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page / of <br />