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SAN JOAQUIN COUNTY <br /> _ z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwW.sjgov.org/ehd <br /> �lFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA ® INSPECTION DATE <br /> immmimmmmamm <br /> S cture Operation Water Well f <br /> ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ 2. Cross-Connection r <br /> Stru a Operation Manure Manageoient OWNER/OPERATOR PHONE <br /> ❑ E) 3. Spreading and isking 4t f7 ® 0 <br /> ❑ ❑ 1 4. Concrete Tag4s INSPECT46N TYPEPROGRAM ELEMENT RECORD ID <br /> [15. Lagooning <br /> ❑ ❑ 6. Composti g The Items below represent code violations and must be corrected: <br /> Structure 04-tion Bird Disp6sal <br /> ❑ 7. Bu i with 2"of Cover P l C <br /> ❑ 8. A oved Concrete Tank <br /> ❑ ❑ 9. 56moval from Premises ( p <br /> Structure Operation V or Control <br /> ❑ ❑ 0. Domestic FI <br /> 1. Fannia FI <br /> ❑ ❑ 14 Larvae Izz C'° <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. dult 36 e K <br /> ❑ 15. L)Iiht Population <br /> ❑ 16. M erste Po ulation <br /> ❑ ❑ 17. HeAy Population <br /> Structure Aeration Feeding0ater Irf <br /> ❑ ❑ 18. Water 14oughs <br /> ._�. r <br /> 11 El 19. Cups or owls a R <br /> 20. Food Sto e <br /> jStrure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings S , <br /> ❑ ❑ 23. Cleanin Fr uenc .41 <br /> p <br /> Structure Operation Water Well lei <br /> ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Property Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 0 El 6. Covin p <br /> [_ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ L ❑ 1 8. Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition v <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. InsecWermin a /` JCarM <br /> Structure Operation Animal Dis oral <br /> 70 <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structureoperation Sewage Disposal <br /> ❑ e--❑ 16. Septic System / <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination REC D INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page`/•._of <br />