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ota�ly c SAN JOAQUIN COUNTY 0 <br /> � •�.+•.oma <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • c��:,: ��• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> phi <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSP CTIONDATE <br /> Structure Operation AcA-g 'e- 00 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 14seto <br /> Structure Operation Manure Managem6rit OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and sking e - 5 S / <br /> ❑ ❑ 4. Concrete Tan INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 5-ilC) � <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp sal <br /> ❑ ❑ 7. BurvindWith 2"of Cover <br /> ❑ ❑ 8. Ap ved Concrete Tank <br /> ❑ ❑ 9. Wmoval from Premises <br /> Structure Operation V96tor Control <br /> ❑ ❑ A. Domestic FIV 3 s <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. HeavV Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls <br /> Ell ❑ 20. Food Storage <br /> S re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walts/Ceilin s <br /> ❑ ❑ 1 23. Cleaning Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 11 2. Cross Connection <br /> Structure Operation Floors <br /> 1-1 ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 1 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> rftr;c�ture <br /> Operation Animal Disposal <br /> 14. Removal from Premises <br /> 15. Other <br /> Operation Sewage Disposal <br /> ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> structure Operfition Rabies Vaccination s INSP! TOR <br /> ❑ ❑ 18. Certificate on Premises ,2mB/ro 3 <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page Z of_ <br />