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6AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> c�4:. .,.:;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA I 1 & 9 INP C N D T <br /> Structure Operation Water Well Dfl� SOOW <br /> ❑ ❑ 1. Well Construction PRE ISE ADDRESSRE-INSPECTION DATE <br /> ❑ ❑ 2. Cross nection <br /> Structure Operation Manure Wanagement OWNE OPE OR ® PHONE <br /> ❑ ❑ 3. Sprea ng and Disking <br /> ❑ ❑ 4. Con ete Tanks IN CTION PE PR GRAM EMENT CORD ID f� <br /> ❑ 5. La ning (tel av`e jLI V <br /> ❑ ❑ 6. C mposting The items below represent code violations and must be corrected: <br /> Structure Operation Biro Disposal <br /> ❑ ❑ 7. urying with 2"of Cover <br /> ❑ ❑ <br /> Approved Concrete Tank c o <br /> ❑ ❑ Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> El 11. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ 13. Pupae t ' c <br /> El 14. Adult 1 1 c <br /> ❑ rolpemation <br /> 15. Li ht Po ulation klj16. Moderate Po ulation <br /> 17. Heav Po ulation <br /> Structure FeedingMater <br /> ❑ ❑ 18. Water Troughs r <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage �a <br /> Struc re Operation Houses +L anind <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> t <br /> Structure Operation <br /> ❑ 1 jNwJconstrucrion SkP <br /> 2. Connection c <br /> Structure Operation Ioors w 1 1pead «- <br /> ❑ ❑ 3. roperly Graded to Sewer e a <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> 1-1 ea 'ng Frequency <br /> Structure OperatiEon <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ ge!OWnlng Frequency <br /> Structure Operation <br /> ❑ 10. ition <br /> 1. Sanit tion <br /> StructureOperation Food <br /> 11Stora e <br /> El El InsecWermin <br /> StructureOpe o .-Animal Dis 03a1 <br /> El 14. Removal from Premises <br /> ❑ 15. <br /> Structure pperayon Isposal <br /> a ❑ ;6. Septic Stem a <br /> Structure peratlon able CClnation ED dill, I IN EC <br /> ❑ ❑ 18. Certificate on Premises A <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />