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oq�i F oa"'�e• <br />0Do3l► <br />10 SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />VECTOR CONTROL INSPECTION FORM <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 l l <br />Page ! of <br />DBA -er- Fe Ke ti n <br />/ <br />I <br />TN <br />It��E f � �� <br />Structure Operation <br />1:1 <br />1:11. <br />Well Construction <br />PREMISE ADDRESS <br />/+ 1 <br />l _ <br />1n p <br />/I% v <br />R``E-t SPECTION DATE <br />E] El 2. Cross-Connectio <br />Structure <br />Operation <br />Manure Mana ent <br />OWNER/OPERATOR <br />•/ T r <br />PHONE <br />(°-- J H <br />11❑ 3. Spreading a Disking <br />❑ <br />❑ <br />4. Concrete T nks <br />1 PECTION PE 7 ` _/ <br />(� 'ru- Zws C 1 i on <br />PROGRAM ELEMENT <br />R ORDID <br />/► _ <br />o l "d o'sR <br />❑ ❑ 5. Lagooni <br />❑ <br />❑ <br />6. Compo ting <br />The items below repro ent code violations and must be corrected: <br />Structure <br />Operation <br />Bird D• posal <br />❑ ❑ 7. Bu ing with 2" of Cover <br />❑ <br />❑ <br />8. A roved Concrete Tank <br />vt ny� <br />_ ' I ► ` 11Q <br />r <br />{J r I L�� u ✓ a <br />1:1 El 9. emoval from Premises <br />Structure <br />Operation <br />V ctor Control <br />❑ ❑ 0. Domestic FI <br />El <br />11. Fannia FI <br />1 t 1 <br />/} ) gay, <br />�� are -I Y M� 0� <br />11 1:112. Larvae <br />❑ <br />❑ <br />13. Pu ae <br />j <br />❑ ❑ 14. Adult <br />❑ <br />15. Light Population <br />-'t1.'r ��C �� <br />�tOV v�`C�` I•� "' `'J <br />❑ 16. Moderate Population <br />❑ <br />17. Heavy Population <br />Structure oration Feeding/Water <br />❑ <br />❑ <br />18. WaterTrou hs <br />1 1 <br />�� <br />1 J I? � <br />A,� <br />� Jt Ir '' t o r 1-h <br />El 1:119. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />StructuretA Operation Houses <br />❑ <br />❑ <br />21. Floors <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleanin Frequenc <br />�I GC r ��� � ` <br />V\ <br />►r` <br />Structure <br />q peration <br />W!1 -Well <br />�V <br />}I <br />11 �✓ m �1 <br />J I• ��ii <br />❑ 1 ell nstruction <br />2. Cross Connection <br />Structure Operation Floors <br />❑ <br />❑ <br />3. Properly Graded to Sewer <br />❑ 4. Drain <br />❑ <br />5. Smooth/Cleanable/ <br />' o h c o S <br />n <br />L"r lr Y �Gr <br />El❑ 6. Covin <br />❑ <br />❑ <br />7. Cleaning Frequencyf� <br />V S <br />Structure Operation Walls <br />El 1,4/,0 r <br />8. Smooth/Cleanable <br />❑ ❑ 9. Cleaning Frequency <br />Structure <br />9peration <br />Cages <br />❑ 10. Condition <br />❑ <br />11. Sanitation <br />Structure Operation Food <br />El0 <br />12. Storage <br />El 13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />❑ 14.45GTwik from Premises <br />❑ <br />❑ <br />, <br />Structure Operation Sewa a Disposal <br />❑ <br />❑ <br />16. S stern <br />[j[:]17. Sewer <br />Structure <br />erAtion <br />Rabies Vaccination <br />RECEIVED BY, <br />sem.. <br />INSP <br />❑ 18. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 l l <br />Page ! of <br />