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SAN JOAQUIN COUNTY <br /> ).•'�.yFE'•.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 600 East Main Street Stockton, CA 95202-3029 <br /> • c� .•- ;•a;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA \ INSPECTION DATE <br /> Structure Operation E :)r� Z_ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection -306A, CJ _ <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 1 3. Spreading and Disking 4:�;o <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning "H,is- r <br /> ❑ ❑ 6. Composting The items 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 NEE] <br /> Vector Control } <br /> ❑ 10. Domestic FI �� \ / <br /> 11. Fannia FI <br /> ❑ 12. Larvae -111(01 CA K❑ 13. Pu ae <br /> 14. Adult <br /> ❑ ❑ 15. Light Population /� <br /> ❑ ❑ 16. Moderate Population �' 1itz, 6drL C, 9fX3:nL1K4.1"e- <br /> 17. Heavy Population <br /> Structure Operation Feeding/Water - t <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 1 20. Food Storage 7 <br /> Structure Operation Houses G, c4.yZ y <br /> ❑ ❑ 21. Floors \ <br /> ❑ ❑ 22. Walls/Ceilings Lt>1 <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> �i <br /> Structure Operation Water Well I <br /> ❑ ❑ 1. Well Construction "7 01,IVl 1 <br /> MLA- <br /> 0 ❑ 2. Cross Connection <br /> Structure Operation Floors ,/ irk- <br /> 1 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Coving116 <br /> CJS i <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition r iYl I <br /> ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ 13. Insect/Vermin f <br /> Structure Operation Animal Disposal \ <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other ` <br /> Structure Operation Sewage Disposal I { <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIV BY IN P TO <br /> ❑ ❑ 18. Certificate on PremisesL)`/ <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page L of 1/ <br />