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, <br /> SAN JOAQUIN COUNTY <br /> Gi< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • a�:.-: ;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA , INSP CTION DATE <br /> Structure Operation <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTI N ATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNERIOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking ®` <br /> ❑ ❑ 4. Concrete Tanks 1. ECTI N TYPE FROG LEMENT` RECORD ID <br /> ❑ ❑ 5. Lagooning V41 S _T / <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with T of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI rNY 7 c®C <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult . <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure operation Feeding/Water -on a22 gfzw&1C <br /> •- C <br /> ❑ Cl 18. Water Trou hs _ <br /> El El19. Cu s or Bowls s <br /> El 0 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure operation Water Well ki <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> S cture Operation Floors n <br /> ❑ 3. Proed Graded to Sewer jR <br /> 1:1 C14. Drain A <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure *-tion Walls ° t <br /> ❑ 8. Smooth/Cleanable v <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operatio Cages $ <br /> ❑ ❑ 10. Condition Y /T <br /> 1. Sanitation <br /> Structure Operation Spod <br /> ❑ ❑ 12. Storage <br /> 13. sect/Vermin <br /> Structure operation Aninfel Disposal <br /> c <br /> El 1:114. Re .1 from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage ' posal <br /> ❑ ❑ 16. Septic S em <br /> ❑ ❑ 17. Sewer cialL,zelfl, <br /> Structure Operition Rabies Vaccination RECEIVED BY INSPE R <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_ f <br />