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SAN JOAQUIN COUNTY I <br /> r 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 /> VECTOR CONTROL INSPECTION FORM <br /> DBA � INSPEC N AT <br /> Structure Operation ®�� f ^� // <br /> ❑ ❑ 1. Well Construction PREMISE ADDRES RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection � <br /> Structure Operation Manure Manage nt OWNER/OPERATORP ONE <br /> 11 3. Spreading and king 'Oc/" 9 3 73 7 Y07 <br /> ❑ ❑ 4. Concrete Tanq INSPECTION TYPE PROGRAM ELEMENT RE ORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispoal <br /> ❑ ❑ 7. Burvinq4ith 2"of Cover <br /> ❑ ❑ 8. Appr ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Vec r control <br /> ❑ ❑ 10 Domestic FI <br /> El 0 it. Fannia FI <br /> ❑ ❑ jf2. Larvae <br /> 'A v4e- <br /> 0 ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ EY 16. Moderate Po ulation 4 <br /> ❑ 71 17. Heavy Population <br /> Structure O enation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> 1:1 El19. Cups or Bowls <br /> 0 10120. Food Storage <br /> Stnuctu Operation Houses <br /> ❑ 21. Floors <br /> in ❑ 22. Walls/Ceilings / <br /> ❑ ❑ 23. Cieanin Fr uenc <br /> Structure Operation Vike Vol1 <br /> ❑ ❑ 1. W nstruction <br /> El f_1 2,_Q&s_sCahnection <br /> Structure Ope n Floors <br /> ❑ ❑', -7T.--PmpedyGraded to Sewer <br /> ❑ . Drain <br /> ❑ 14 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> Frequency <br /> Structure Operation W9 <br /> ❑ 8. Smooth/Cleanable <br /> ❑ ma '9._.Q1,eaning Frequency <br /> Structure Opera Ca <br /> ❑ EL t, 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> EI El 1 <br /> Structure Operation Animal Dis OSai <br /> ❑ Rj-'11171twW75116m�Premises <br /> ❑ 0 15 <br /> Structure Operation ewage Dis <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 1 <br /> Structure Op o Rabies Vaccination EIVED Fy IN P C OR <br /> ❑ 18. remises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04!08 <br /> Page of <br />