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SAN JOAQUIN COUNTY z Z ENVIRONMENTAL HEALTH DEPARTMENT '. 600 East Main Street Stockton, CA 95202-3029 ''� • �;:.- ;.N;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd �lFOR VECTOR CONTROL INSPECTION FORM DBA INSPECTION DATE Structure Operation Water Well 61Y'" ' ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE ❑ ❑ 2. Cross-Connection Structure Operation Manure Mana ementNER/OPERATOR PHONE ❑ ❑ 3. Spreading and Disking 0?0q ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORDID ❑ ❑ 5. Lagooning 3. 5� Pl)o L ❑ ❑ 6. Composting The items below represent code violations and must be corrected: Structure Operation Bird Disposal ❑ ❑ 7. Burying with 2"of Cover ❑ 1 ❑ 8. Approved Concrete Tank ❑ ❑ 9. Removal from Premises Structure Operation Vector Control ❑ ❑ 10. Domestic FI 11. Fannia FI ❑ ❑ 12. Larvae A , • ❑ ❑ 13. Pupae ❑ ❑ 14. Adult ❑ ❑ 15. Light Population ❑ ❑ 16. Moderate Population a ❑ ❑ 17. Heavy Population Structure Operation FeedingANater -I ❑ ❑ 18. Water Troughs ❑ ❑ 19. Cups or Bowls ❑ ❑ 20. Food Storage Structure Operation Douses \ . ❑ ❑ 21. Floors V \ El ❑ 22. Walls/Ceilings \ 41:? zrnmnk ❑ ❑ 1 23. Cleanin Freuenc Structure Operation Water Well - ❑ ❑ 1. Well Construction ❑ 2. Cross Connection Structure Operation Floors ❑ ❑ 3. Propedy Graded to Sewer ❑ ❑ 4. Drain ❑ ❑ 5. Smooth/Cleanable ❑ ❑ 6. Covin ❑ ❑ 1 7. Cleaning Frequency Structure Operation Walls MCA I ❑ ❑ 8. Smooth/Cleanable ❑ 1:19. Cleanin Fre uenc i 0 Structure Operation Cages ❑ ❑ 10. Condition ❑ 11. Sanitation Structure Operation Food f VAA ji, 6p,Da f w eai- El ❑ 12. Storage El ❑ 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 RECEIVED B INSPE P ❑ ❑ 18. Certificate on Premises VECTOR CONTROL INSPECTION FORM EHD 40-06 12/04/08 Page of