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IDSAN JOAQUIN COUNTY <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> �. X <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <br /> �IFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESSRE-INSPECTION DATE <br /> 1:1 El2. Cross-Connection 4 S <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking c q <br /> El E] 4. Concrete Tanks INSPECTION TYPE P GRAM ELEMENT RECOR ID <br /> ❑ ❑ 5. Lagooning 5- <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 S r^ <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI 9 <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 1 19. Cups or Bowls <br /> 20. Food Storage % <br /> Structure Operation HousesCo Amag ®tom <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction ? <br /> 2. Cross Connection t <br /> Structure Operation Floors S ^° a ie f r <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> d <br /> ❑ 61 ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls a 5 <br /> ❑ ❑ 1 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food F <br /> ❑ ❑ 12. Storage <br /> 13. InsecWermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ je X ❑ 16. septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Opedtion Rabies Vaccination R CEI, D IN CTO <br /> ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page,7-of_ <br />