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r� <br /> SAN JOAQUIN COUNTY <br /> X 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 /> VECTOR CONTROL INSPECTION FORM <br /> DBAINSPECTIO DAT <br /> Structure Operation /0/ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS , RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection IX,7jl <br /> Structure Operation Manure Mana eme t OW ER/OPgTOR PHONE <br /> 1:1 ❑ 3. Spreading and Dis ing te >7 1 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPEPROGRAM ELEMENT REC RD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composfing The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos I <br /> ❑ ❑ 7. Burying h 2"of Cover ® r j <br /> ❑ ❑ 8. Approvq6Concrete Tank <br /> ❑ ❑ 9. Remo al from Premises t <br /> Structure Operation Vector/Control <br /> ❑ ❑ 10. mestic F! <br /> 11.4annia FI <br /> ❑ ❑ 1 Larvae <br /> ❑ ❑ 14. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure Ope tion Feeding/Water <br /> ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls he <br /> El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors r� <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 1 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable ®•� ® �, <br /> El 0 6. Covin <br /> El _L Cleaning Frequency <br /> Structure Operation Walls <br /> 1:111 8. Smooth/Cleanable lo�Jm <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> El F110. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 1 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operktion Rabies Vaccination EI I ASPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />