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F , . 4 <br /> 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 /> VECTOR CONTROL INSPECTION FORM <br /> DBA ly& INSPCTI�N DATE <br /> Structure OperationWater Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> / / <br /> ❑ ❑ 2. Cross-Connection "_ )Vlazl <br /> Structure Operation Manure Management OwNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Diskin <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE P%�ELEMENT RECORD ID <br /> ❑ 5. Lagooning e S <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposailt <br /> ❑ ❑ 7. Bu in w' 2"of Cover / v <br /> ❑ ❑ 8. Awl Concrete Tank <br /> ❑ ❑ 9. Rem ai from Premises 1 <br /> Structure Operation Vect Control IF <br /> ❑ ❑ 10.komestic FI <br /> 0 Li 11 Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ Ix <br /> 14. Adult Li <br /> ❑ 15. ht Po ulation <br /> 16. Moderate Po ulation❑ 17. Hea Po ulation <br /> Structure Feeding/Water <br /> El18. Water Trou hs �. e <br /> ❑ ❑ 19. Cu s or Bowls <br /> 20. Food Storage <br /> s Operation Houses <br /> ❑ 21. Floors ®" r <br /> ❑ 1 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fr uenc <br /> Structure Operation Water Well o <br /> ❑ ❑ ill 1. Well Construction h <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. PropedyGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 0 6. Covin <br /> 11 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ NV15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ _ 1116. Septic System <br /> ❑ ❑ V1 7. Sewer <br /> Structure opedtion Rabies Vaccination RE NE IN OR <br /> ❑ ❑ 18. Certificate on Premises (' <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of l <br />