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SA&AQUIN COUNTY <br /> A .�.E'•.O <br /> - .- a 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 /> �rFOR�' <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DAT <br /> Structure Operation I vo <br /> - <br /> ❑ ❑ 1. Weli Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. CrossConnection I <br /> Structure Operation Manurlif Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Sp r ading and Disking y\ --7osL <br /> ❑ ❑ 4. C ncrete Tanks IgISPEC N TYPE PROGRAM ELEMENT RE ORD ID <br /> 111-] 5. gooning 'IlI�L-\ L71-t <br /> E] ❑ 6. tornposting The items below represent code violations and must be corrected: <br /> Structure Operation rd Disposal <br /> ❑ ❑ Burying with 2"of Cover e \ S CA Ce CJCCALE4� <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ 9. Removal from Premises 1 <br /> Structure opera'on Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 1:1 El 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 3. Pupae <br /> ❑ 1 Adult <br /> ❑ KOpemtlon <br /> 15. i ht Population <br /> ❑ 16. erate Population <br /> ❑ 17. He Population <br /> Structure Feedin ater (� ` <br /> ❑ 18. Water T u hs <br /> ❑ 19. Cu or Bo s 'S1?M Y-n / <br /> 0 El 20. Food Stora <br /> Structure Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings A510 e v ci-cc i <br /> ❑ ❑ 23. Cleanina Fre uenc <br /> MENEENEMEM I's ),I <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction e® 1 <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> El ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 0 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> El Lj 13. Insect/Vermin <br /> Structure Operation Animal Dis oral <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal 4 <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer l "r+b„I <br /> Structure Oper3tlon Rabies Vaccinatio REC ED BY IN R <br /> El 1118. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page 1 of i <br />