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"'^� c SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> . :•. �P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> thio- <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA ¢ �) �/ _ INSPECTION DATE <br /> Structure Operation n r S G h �C.c,4 v %V110 <br /> ❑ ❑ 1. well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3 / / 0 <br /> St cture Operation Manure Mana em nt OWNER/OPERATOR PHONE <br /> ❑ 3. Spreading and D' king 11 is- ld4* -+ Rp jI X-9- 3V 13 <br /> El 114. Concrete Tank INS CTION TYPE PROGRAM ELEMENT ECORD ID <br /> ❑ ❑ 5. Lagooningdddzt-Zqys 000 to Q <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure enation Bird Disp sal <br /> ❑ 7. Bu i with 2"of Cover _ C LE <br /> El8. A oved Concrete Tank <br /> ❑ ❑ 9. moval from Premises <br /> Structure Operation V for Control <br /> ❑ ❑ Y6. Domestic FI <br /> ❑ 0 Al.. Fannia FI <br /> ❑ El h. Larvae i <br /> ❑ ❑ 1A Pupae <br /> ❑ 14.Vdult <br /> ❑ 0 15. L ht Po ulation <br /> ❑ 16. M erste Population S <br /> ❑ ❑ 17. Hea\y Population <br /> Structure Operation Feeding ater <br /> ❑ ❑ 18. Water ou hs <br /> ❑ ❑ 19. Cups or owls 3 rood f,( <br /> ❑ 20. Food Stor e <br /> St cture Operation Houses <br /> ❑ El21. Floors <br /> ❑ El22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors " S <br /> ❑ ❑ 3. Properl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. CleaningFrequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency (f/ Pc7� C <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ C 157 ❑ 12. Storage <br /> 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ r,Operation <br /> 14. Removal from Premises _ <br /> ❑ 15. Other <br /> Structure Sewage Disposal <br /> 1:1 16. Se tic S stem <br /> ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEN INSPEg7OR <br /> ❑ C�VLII 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of� <br />