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041'" SAN JOAQUIN COUNTY <br /> y-+ 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 /> �IFOR ® ® ®p� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation S 1///S <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ 2. Cross-Connection X1 <br /> S re Operation Manure Mana eme OWNER/OPERATOR PHONE <br /> ❑ 3. Spreading and Dis ng <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items bel represent code violations and must be corrected: <br /> Structure op tion Bird Dispogfil <br /> ❑ El, 7. Bu in ith 2"of Cover i <br /> ❑ ❑ 8. A ro ed Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vec r Control <br /> ❑ ❑ 1 omestic FI <br /> 7. c. <br /> 1 AFannia FI <br /> ❑ ❑ 2. rvae <br /> ❑ ❑ 13. P ae <br /> ❑ ❑ 14. AAM a0la MAel'MAVAe'01 <br /> ❑ ❑ 15. Li ht o ulation <br /> ❑ 16. Modeilile Population " <br /> ❑ 17. Heavy ulation <br /> Structure O ration Feedingm er <br /> ❑ ❑ 18. Water Trou s <br /> 019. Cups or Bo S` <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> 43 ❑ 23. Cleaning Frequenc <br /> S <br /> tructure Operation Water Well <br /> ❑ 1. Well Construction <br /> El 2. Cross Connection <br /> Operation Floors , <br /> ❑ 3. Proerl Graded toSewer <br /> ❑ 4. Drain A707 QC hZt7e a-.,-,f22 ZWrt�n❑ 5. Smooth/Cleanable <br /> 11 El 6. Covin7. Cleanin Fre uenc operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency f Ue <br /> Structure Operation Cages <br /> ❑ ❑ 1 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage , <br /> 13. InsecWermin <br /> Structure Operation Animal Dis al <br /> ❑ ❑ 14. Removal from Premises ° J9 YV <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies VaccinationINSPECT0 <br /> ❑ 1118. Certificate on Premises E D <br /> a LceA2 <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 Page Of <br />