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a"I" .g <br /> SAN JOA I COUNTY <br /> �o , od <br /> w <br /> y ENVIRONMENTAL HEALTH DEPARTMEN'i' <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �/PORN <br /> 7 VECTOR CONTROL INSPECTION FORM <br /> DBA t IN®SPECTI N DAT <br /> Structure Operation .Cr R] I <br /> ❑ 1. Well Construction PREMISE ADDRESS RE-INS ECTIO DATE <br /> El 2. Cross-Connection / 4 <br /> structu Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 1 3. Spreading and Disking ComriiI6 <br /> e,I 1 I'd 1 7 <br /> ❑ ❑ 1 4. Concrete Tanks 10SPECTION TYPE PROGM ELEMENT RECO® DID <br /> ❑ ❑ 5. Lagooning -C P <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure tion Bird Disposal <br /> ❑ 7. B Ang with 2"of Cover <br /> ❑ 8. Approved Concrete Tank ¢ dt C <br /> ❑ ❑ 9. Removal from Premises <br /> Structure operatio Vector Control S /� <br /> ❑ ❑ 10. Domestic Fly 4rrlt,�q <br /> 11. Fannia FI �* <br /> ❑ ❑ 12. Larvae d , rw Ah- r �3 <br /> 11 El 3. Pupae <br /> ❑ ❑ 1%. Adult <br /> ❑ ❑ <br /> A Light Population e t� a aT <br /> ❑ ❑ 16. oderate Population r 6 / <br /> ❑ ❑ 17. F6avy Population <br /> Structure Operation Feedi g/Water r CC <br /> Trouahs <br /> ❑ ❑ 19. Cu tsr r Bowls ` '�c .L�t <br /> El 0 20. Food !orae , t <br /> Structure operation Houses j <br /> 11 1121. Floors <br /> ❑ ❑ 22. Walls/Cei'n s bo-br <br /> ❑ 1123.Cleaningfnequency <br /> Structure 6operation Water Well <br /> ❑ Well Co truction n S -c> <br /> 11 2. ross Connection I I aft <br /> Ij <br /> Structure tion Floors <br /> ❑ ❑ 3. ProperlyGraded to Sewer <br /> ElD ' J <br /> �+ <br /> ❑ <br /> n c . vj\)-ffiw Gln <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> 7. Cleaning Frequency ,/^ <br /> StructufOperation <br /> Wells <br /> , r e <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. CleaningFrequency <br /> Structure Cages <br /> ❑ 10. Condition • <br /> -to vyfto%ig� for <br /> 11. Sanitation a ��1 <br /> StructuFood cpm be- <br /> ❑ 12. Storage t•`,, <br /> 13. Insect/Vermin 1 Y l <br /> Kbmt)- <br /> StructuAnimal Dls oral <br /> ❑ 14. emoval Premises <br /> ❑ ❑ 1 15. Other /P' <br /> Structure OperationSewage Disposal t <br /> ) R'Wordcs ID acr,-C� <br /> ❑ ❑ e ti tem t .. <br /> ❑ ❑ 7. Sewer h11 <br /> -12 <br /> Structure Operation Rabies Vaccination---c v INSPECT <br /> &,:,,. <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of_ <br />