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oAa�t'� SAN JOAQUIN COUNTY <br /> a .4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • :, .;,N;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOPT* 000-0 3LI 9 tt <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAr IN$PEC ON DA <br /> Structure Operation / <br /> ❑ ❑ 1. Well Constructi n PREMISEADDR REIN PECTION DATE <br /> ❑ ❑ 2. Cross-Gonne on DLIO <br /> Structure Operation Manure Mana ement OWN Ed2ATOR PHONE <br /> ❑ ❑ 1 3. Spreading aid Disking 14 1 <br /> ❑ ❑ 4. Concrete T nks INSPEcTION TYPE PROGRAM ELE NT ORD ID <br /> ❑ ❑ 5. LagooninIT <br /> ❑ ❑ 6. compo .ng The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dishosai <br /> ❑ ❑ 7. Bu with 2"of Cover <br /> ❑ ❑ 8. A oved Concrete Tank c e <br /> ❑ ❑ 9. moval from Premises <br /> Structure Operation Ve or Control <br /> c <br /> ❑ ❑ 1 Domestic FI <br /> f12 <br /> . Fannia FI <br /> ❑ ❑ . Larvae <br /> ❑ ❑ 13. Pupae ' % . I <br /> 1:1 El / <br /> 14. Adult <br /> Y) cod <br /> ❑ ❑ 15. Li ht Population Py <br /> ❑ 16. Moderate Population 1 <br /> ❑ 17. Heavy Population 'r C <br /> Structure ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls 1 <br /> 20. Food Storage <br /> strut OperationHouses ° <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings Wak ha--s <br /> ❑ ❑ 23. Cleaning Frequencyv <br /> Structure Operation r e t <br /> ❑ truction • Cmd i-s ® g <br /> ej 6 Sed <br /> 2. Cross Connection o <br /> Structure Operation FI <br /> ❑ ❑ Graded to Sewer <br /> ❑ ❑ <br /> ❑ ❑ C 5. eanable <br /> ❑ ❑ . Cov' <br /> El 7. Cleaning Frequency <br /> tureOperaration Walls ficv <br /> ❑ ogth/Cieanable <br /> 9. CleaningFrequency <br /> eration Cages <br /> ❑ ndition <br /> 1 talion <br /> eration o0 <br /> ❑ -Storage <br /> El 13. Insect/Vermin <br /> oration IDIS oral <br /> Removal from Premises <br /> ❑ 15. Other <br /> enationSewa a Disposal <br /> ❑ 6. tem <br /> ❑ fit ❑ 1 17. Sewer <br /> ! 9prktion to accination REC E Y INSPE R <br /> ❑ ❑ rfificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 —P <br /> Page / of_ <br />