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oq,44?lfy. c SAN JOAQUIN COUNTY <br /> 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 I E ON TE <br /> Stricture Operation Water Well <br /> ❑ ❑ 1. Well Construction PR/EMI E ADDR RE4 SPEC ON DATE <br /> ❑ ❑ 2. Cross-Connection / <br /> Structure Operation Manure Mana eii t OWNER/ RATOR P <br /> ❑ ❑ 3. Spreading and D' ingON~ 4 <br /> ❑ ❑ 4. Concrete Tank/ INSPEC ON TYPE P!r FLEMEr4TC RD ID <br /> ❑ ❑ 5. Lagooning o!5 <br /> ❑ ❑ 6. Composti96 The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp6sai <br /> ❑ ❑ 7. Bury g with T of over <br /> ❑ ❑ 8. A roved Concrete Tank v e e <br /> ❑ ❑ 9. emoval from Premises /Rage <br /> Structure Operation Victor Control <br /> ❑ ❑ 0. Domestic FI ~ <br /> 11. Fannia FI <br /> 11 12. Larvae <br /> ❑ ❑ 13. Pupae0(11 d <br /> ElEy 0P. <br /> Adult <br /> 1:115. Light Population VL A <br /> 1116. Moderate Population <br /> ❑ ❑ 17. HeavyPopulation <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs a <br /> ❑ ❑ 19. cups or Bowls <br /> 20. Food Storage <br /> Stru re Operation Houses <br /> 1121. Floors <br /> M❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanina Fr uenc 'I's <br /> jt <br /> MEMMEM S) <br /> Structure Operation VlatOrYiqll e <br /> ❑ ❑ 1. W nstruction <br /> 2. Cronnection <br /> StructunK Operation FI rS <br /> 11 ❑ Proed Graded to Sewer a <br /> ❑ ❑ n <br /> ❑ 10 0 oth/Cleanable <br /> vin <br /> ea ing Frequency <br /> Structure Operation Walls <br /> ❑ moottdCieanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Oeeration geS <br /> ❑ 10. dition <br /> anitation <br /> Str'uctu Operation <br /> ❑ ❑ r12,Stora e <br /> El 13. ect/Vermin <br /> Structure Operation I i DIS OSal <br /> ❑ ❑ 4. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation a DISpOS81 <br /> ❑ ❑ c S tem o <br /> ❑ ❑ r <br /> Structu Ledtion Rabie Vaccination RECEIVED INSP <br /> ❑ �4$ Certificate on Premi s <br /> VECTOR CONTROL INSPECTION FORM <br /> Page of <br /> EHD 40-06 12!04/08 <br />