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SAN JOAQUIN COUNTY <br />_.� ENVIRONMENTAL HEALTH DEPARTMENT <br />Co..X <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 />VECTOR CONTROL INSPECTION FORM <br />Structure <br />Operation <br />Water Well <br />DBA <br />INSP CTION DATE <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />-?'0,00-f <br />RE -INSPECTION DATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Managepont <br />OWNER/OPERATOR <br />,� <br />PIJONE <br />-71a-2 -7S-- 0,reel <br />❑ ❑ 1 3. Spreading and 94sking <br />❑ <br />❑ <br />4. Concrete Ta s <br />IN PECTION TYPE <br />PROGRAM ELEMENT <br />4W6 -4e <br />RECORD ID <br />® y <br />❑ ❑ 5. Lagooning <br />❑ <br />❑ <br />6. Compos ' g <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disllosal <br />❑ ❑ 7. Bu g with 2" of over <br />❑ <br />❑ <br />8. A roved Concrete Tank <br />❑ ❑ 9. Amoval from Premises <br />Structure <br />Operation <br />VActor Control <br />❑ ❑ 10. Domestic FI <br />11. Fannia Fly <br />® �' A <br />❑ ❑ 12. Larvae <br />❑ <br />13. Pu ae <br />❑ 14. Adult <br />❑ <br />❑ <br />15. Li ht Po ulation <br />❑ ❑ 16. Moderate Population <br />El <br />1117. <br />HeavyPopulation <br />structur Operation Feeding/Water <br />❑ <br />1118. <br />Water Troughs <br />❑ 19. Cups or Bowls <br />20. Food Storage <br />S cture Operation Houses <br />❑ <br />❑ <br />21. Floors <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleanin Fr uenc <br />Structurem0p�ermatlon <br />Water Well <br />❑. Well Construction <br />Cross Connection <br />Structure IOOrs <br />❑❑ <br />3. Pro ri Graded to Sewer <br />El 4. Drain <br />1:1❑ <br />-E] <br />5. Smooth/Cleanable <br />6. Covin <br />El <br />7. Cleaning Frequency <br />Structure Operation Walls <br />❑ <br />❑ <br />8. Smooth/Cleanable <br />❑ ❑ "L-9. Cleaning Frequency <br />Structure <br />Operation <br />Cages <br />❑ ❑ 10. Condition <br />Sanitation <br />structure Operation Food <br />❑ <br />❑ <br />12. Storage <br />13. Insect/Vermin <br />structure <br />Operatbn <br />Animal Dis oral <br />❑ ❑ 14. Removal from Premises <br />❑ <br />❑ <br />. Other <br />Structure Operation Sewage Disposal <br />❑ <br />0^11 <br />16. Se tic S tem <br />❑ ❑ 7. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />lk V BY <br />INSPECTOR <br />❑ ❑ 18. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 <br />Page _ of <br />