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SAN JOAQUIN COUNTY <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> c� :•; ;•:;r Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFORN ® ®p� <br /> VECTOR® CONTROL INSPECTION FORM <br /> SIM=BMW= DBA INSPECTION DATE <br /> > <br /> Structure Operation � 1 <br /> ❑ ❑ 1. Well Construction PREMISE DRESS g REINS ECTION DATE <br /> 1:1 [:12. Cross-Connection 1 <br /> k <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 1 3. Spreading and Disking f/t <br /> ❑ ❑ 4. Concrete Tanks INSPEC7 TYPE PRooPAm ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning V <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. BurvinQ with 2-of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises AD 170k d <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 1 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population S2 <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedingfWater <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walis/Ceilin s �3 444 <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> mmmommomommm <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> El 2. Cross Connection tt <br /> Structure Operation Floors <br /> El ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> El El 7. Cleaning FrequencyK <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequencyy <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food s <br /> ❑ ❑ 12. Storage <br /> 12 <br /> 13. Insect/Verminr* <br /> Structure Operation Animal Dis oral <br /> ❑ ❑ 14. Removal from Premises C 14 AdaC <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal o <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination IVED BY 1 PECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of_ <br />