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SAN JOAQUIN COUNTY <br />�2a ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street Stockton, CA 95202-3029 <br />:.- <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />4�rFOR� <br />VECTOR CONTROL INSPECTION FORM <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 <br />Page _ of <br />DBAINSPECTION <br />(7` <br />DATE <br />Structure Operation <br />❑ <br />❑ <br />❑ <br />❑ <br />1. We!1 Construction <br />2. Cross -Connection <br />PREMISE ADDRESS <br />RE-IRSPECtION DATE <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPERATOR <br />PHONE <br />❑ ❑ 3. Spreading and Disking <br />❑ <br />E] -AAPI❑ <br />❑ <br />4. Concrete Tanks <br />5. Lagooning <br />INSP CTION NP <br />PROGRAM ELEMENT <br />R O D 1 <br />❑ <br />❑ <br />6. Composting <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disposal <br />t <br />d <br />❑ ❑ 7. Burying with 2" of Cover <br />❑ <br />❑ <br />8. Approved Concrete Tank <br />% <br />❑ ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />❑ ❑ 10. Domestic FI <br />11. Fannia FI <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />fa,r1 <br />❑ ❑ 14. Adult <br />❑ <br />❑57- <br />1 15. Light Population <br />? <br />i` 4QAWJ 200- <br />❑ ❑ 16. Moderate Po ulation <br />❑ <br />❑ <br />17. Heavy Population <br />t <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Troughs <br />❑ At ❑ 19. Cu s or Bowls <br />❑ <br />20. Food Storage <br />! <br />Structure Operation Houses <br />❑ <br />❑ <br />21. Floors <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />Structure <br />❑ <br />Operation <br />23. Cleanin Fre uenc <br />Water Well <br />T <br />❑ ❑ 1. Well Construction <br />El <br />11 <br />2. Cross Connection <br />Structure Operation Floors <br />El <br />❑ <br />3. Proed Graded to Sewer <br />❑ ❑ 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />6. Covin <br />7. Cleaning Frequency <br />Structure Operation Walls <br />❑ 0 19 ❑ <br />8. Smooth/Cleanable <br />❑ ❑ 1 9. Cleaning Frequency <br />Structure <br />Operation <br />I Cages <br />s <br />i <br />❑ 0. 4 ❑ 10. Condition <br />13 <br />11. Sanitation <br />Structure Operation Food <br />❑ <br />❑ <br />12. Storage <br />13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />❑ OV 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />16. Septic System <br />❑ ❑ 17. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEIVE BY <br />INSPECYOR <br />❑ Ut Gr 1 18. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 <br />Page _ of <br />