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SAN JOAQUIN COUNTY <br /> .�^•.per <br /> - 'Z+ 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 /> ? 3 VECTOR CONTROL INSPECTION FORM <br /> DBA / 1N§PECjnON D T <br /> Structure OperationCalls <br /> ❑ ❑ 1. Well Construcrioli PREMISE <br /> ADD RE-W PEC ON DATE <br /> El F12. Cross-Conn ' n <br /> Structure Operation Manure Mana ement OWNE OPERAT Rcf PHONE <br /> 11 ❑ 3. Spreading d Disking (�'' ( - 3,S <br /> ❑ 1 4. Concrete auks INSP CTIONRE;E= fkt PROGRAM ELEME T ECO <br /> RD ID <br /> 1:1 ❑ 5. Lagoon' gqws <br /> ❑ ❑ 6. Com sting The items below represent code violations and must be corrected: <br /> Structure Operation Bird qfsposal <br /> ❑ ❑ 7. Bu(yinq with 2"of Cover <br /> ❑ ❑ 8. poroved Concrete Tank <br /> ❑ ❑ 9 Removal from Premises <br /> Structure Operation /lector Control (� It <br /> i s <br /> El 1:110. Domestic FI J WAX- <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 13. Pupae <br /> ❑ 14. Adult 1 <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population s <br /> ❑ ❑ 17. Heavy Population 2) S a + a <br /> Structure Operation FeedingMater ' JQoDd <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowis <br /> 20. Food Storage <br /> s tore operation Houses o <br /> ❑ 21. Floors <br /> 'e are- <br /> 0 ❑ 22. Walls/Ceilings -3.) k�� --s Vat C k\ <br /> ❑ ❑ 23. Cleaning Frequency <br /> tr <br /> Structure ration W <br /> ❑ ❑ 1. nstruction L4 e 1� <br /> 2. nnection <br /> Structure Operation floors F <br /> ❑ ❑ Gradedto Sewer <br /> ❑ ❑ 4. Drain �° ,s on a, <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 0 6. Covin <br /> El 0 7. q!Wning Frequency <br /> Structure Operation ails <br /> ❑ ❑ mooth/Cleanable e <br /> ❑ ❑ 9. Cleaning Frequency fGm&rLa <br /> Structure Operation ages <br /> ❑ ❑ ition <br /> 13 11 <br /> 1 ion <br /> Structure Operation <br /> 13 ❑ e <br /> 13. insecwermin <br /> Structure Operation Awlfffial DIS I <br /> ❑ ❑ va m Premises <br /> ❑ ❑ 1 . <br /> Structure Operation @Wa Osal <br /> ❑ El6. Se tic S tem t <br /> 11 1:1 - <br /> Structu Operation Rabigs4accination R I INSPECTO <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of_ <br />