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r <br /> U"! <br /> SAN SAM JOA ICOUNTY <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • 4:.- - ;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �/FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA a. INSPECTION DATE <br /> Structure Operation /�" 1.0 12,11 Cf <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ El2. Cross-Connection ®/ / 7 <br /> Structure Operation Manure Management/ OW R/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disk' g 70-?(?' <br /> ❑ ❑ 4. Concrete Tanks INS CTION TYPEPROGRAM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning �" �/ -? <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispO 1 <br /> ❑ ❑ 7. Burvinq ith 2"of Cover <br /> ❑ ❑ 8. ApproA Concrete an <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vect6r Control <br /> ❑ ❑ 10 Domestic FI <br /> El 11. Fannia FI <br /> ❑ A2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population �- <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structureteration FeedingMater <br /> ❑ 18WaterTrou hs <br /> 19. Cu s or Bowls _ o <br /> 20. Food Storage <br /> Structu Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings 9 -Prz 1 1' <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation <br /> ❑ ❑ 1. Well Construction s /'S <br /> Connection <br /> Structure Operation Flo <br /> ❑ ❑ 3. Property Graded to Sewer <br /> ❑ ❑ . Drain - �> <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 11 El 6. Covin <br /> 11 11nin Frequency <br /> Structure Operation WalA-eeW -14a <br /> ls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. CleaningFrequency <br /> Structure Operation a es <br /> ❑ ❑ 10. Condition <br /> 1 nitation <br /> StructureNOperation/ Food❑ 2Stora e <br /> El El <br /> StructureAnimal Dis❑ 14. Removal from Premises <br /> ❑ 15. Other <br /> Structure Operation j Sewage Disposal <br /> ❑ ❑ ftSe tic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operition Rabies Vaccination RE NE i3Y IN c R <br /> ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> ' Page of <br />