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SAN JOAQUIN COUNTY <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> ���fFOR�'��• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Well /0M-//10 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection /3 7 <br /> 1 7 <br /> Structure Operation Manure Management OWNkWOPERATOR lei P ONE <br /> ❑ ❑ 3. Spreading and Diski g t441"Oe- <br /> 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RE ORD ID <br /> ❑ ❑ 5. Lagooningtems <br /> El El 6. composting he ibelow represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Burying 2"of Cover ,J <br /> ❑ ❑ 8. Appro4 Concrete Tank <br /> ❑ ❑ 9. Remo al from Premises <br /> Structure Operation Vecto Control <br /> ❑ ❑ 10. 96mestic FI <br /> 11.kannia FI <br /> ❑ ❑ <br /> I/Larvae c r< <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population ,- <br /> ❑ 17. Heavy Population <br /> Structure Ope tion FeedinglWater <br /> ❑ 18. Water Troughs <br /> ❑ ❑ 19. CU s or Bowls f <br /> El El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings ' C <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑^il 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Proeri Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ . Smooth/Cleanable <br /> 11 0 6. Covin <br /> 11 7. Cleaning Frequency <br /> Structure Operation WaIlS <br /> ❑ ❑ 1 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 0. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ Storage <br /> 11 El V 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic S tem <br /> ❑ ❑ 17. Sewer <br /> Stricture Operation Rabies Vaccination REcE D B IN T R <br /> 11 El18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />