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oQQutN c SAN JOAQUIN COUNTY <br /> Q �y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> ••���/FOR��� Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation C.t '-1 - - <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS a RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking ` y7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION Typt PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning -� <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 I <br /> ❑ ❑ 9. Removal from Premises �• �- i <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> El El 11. Fannia FI <br /> ❑ ❑ 12. Larvae y6 \ �= <br /> El El 13. Pupae 6f " <br /> ❑ ❑ 14. Adult �, fk2PiAcAVV\_ t i <br /> ❑ ❑ 15. Light Population j <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses y <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings ^✓ <br /> ❑ ❑ 23. Cleaning Frequency <br /> t ^ 3 <br /> structure Operation Water Well �i <br /> El E] 1. Well Construction <br /> ❑ El 1 2. Cross Connection <br /> Structure Operation Floors / t <br /> ❑ ❑ 3. Proper) Graded to Sewer <br /> ❑ ❑ 4. Drain l '- A <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin y S <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency C <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El Ej 11. Sanitation _ <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insectivermin <br /> Structure Operation Animal Disposal y y ` /� <br /> 1:1 1:114. Removal from Premises Z S `�( 6 �'r <br /> ❑ ❑ 15. Other t <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operhtion Rabies VaccinationRECEIVE Y,,�y INS fi0 <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 , ' Paged of <br />