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SAN .JOAQUIN COUNTY <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • P" Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> StructureOperationWater Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REIN PECTI N DATE <br /> ❑ ❑ 2. Cross-Connection G( <br /> Structure Operation Manure Management OWNER/CffiERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking t yf M- <br /> ❑ ❑ 4. Concrete Tanks _!IOPECTION TYPE PROGRAM SLEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 9 V s- <br /> ❑ ❑ 6. Composting The terns below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises ^« <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FlyL42LILfi <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult r� <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population r <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <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. Cleanin Fr uenc <br /> MEMEMMEME <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Stru ur Operation Floors <br /> EA 11 1 3. Properly Grade to Sewer <br /> ❑ ❑ 1 4. Drain <br /> ❑ ❑ 5. Smooth/CI nable <br /> 6. Covin <br /> El 1:1 7. Cleanin4 Frequency <br /> Structure Operkon Walls <br /> ❑ ❑ 8. S th/Cleanable <br /> ❑ ❑ k 9. dleaning Frequency <br /> Structure Operation ges <br /> ❑ ❑ Condition <br /> 11. anitation <br /> Structure- Operatlo Foo <br /> ❑ ❑ 12. St o e <br /> 13. Inse ermin <br /> Structure Op tion Animal Oloposal <br /> ❑ ❑ 14. Removal m Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Dispo I <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY-2 <br /> Y INSPE R <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of_ <br />