Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> p 'z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> M 600 East Main Street Stockton, CA 95202-3029 <br /> c�4:,_: . Telephone: (209)468-3420 Fax:(209)404-0138 Web:wwwsjgov.org/ehd <br /> �/FORS <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Well LiPv�r <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS Rif-NSPECTfON DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure management It/ PERAT PHONE <br /> ❑ ❑ 3. Spreading and Disking f <br /> ❑ ❑ 4. Concrete Tanks I CTIO PEJ PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning i/,/s / <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal 111) <br /> ❑ ❑ 7. Bu in with 2"of Cover ` !' <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fly ed d 2 ° 1.2 <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult i3Zel 12,,g <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Po ulation / <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water t4AXA Z.�Ce21 <br /> ❑ ❑ 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 Fre uenc <br /> L` <br /> Structure Operation Water Well , <br /> ❑ 1. Well ConstAction l <br /> El 1 2. Cross Co nection <br /> Structure Operation Floors e <br /> ❑ ❑ 3. Proa Graded to Sewer <br /> ❑ ❑ 4. Drai <br /> ❑ 5. S th/Cleanable <br /> 11 6. vin <br /> 7. leanin Frequency <br /> Structure Operation IIS <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency 9't s <br /> Structure Operation C es <br /> ❑ ❑ 10. ndition <br /> 11. S itation <br /> Structure Op ion Food <br /> ❑ 12. Sto e <br /> 13. Ins ermin �- r <br /> Structure peration Animal Di oSal <br /> ❑ ❑ 14. Removal Premises ` S' <br /> ❑ ❑ 15. Other <br /> Structu Operation Sewage Dispo I <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> structure Opedtion Rabies Vaccination RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of_ <br />