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SAN JOAQUIN COUNTY <br /> W X <br /> 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 /> �IFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA (NSN D <br /> Structure Operation • ^ , PECTI/ 6f <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-IN#PECTION DATE <br /> ❑ ❑ 2. Cross-Connectio <br /> Structure Operation Manure managofnent OWNER/OP TOR PHONE t <br /> El El3. Spreading an Disking / ;?7^61.311r <br /> ❑ ❑ 4. Concrete T nks INS TION TYPE PROGRAM ELEMENT RECORD ID <br /> El [15. Lagooni a 4''SOro S <br /> ❑ ❑ 6. Compoing The items below represent code violations and must be corrected: <br /> Structure Operation Bird D' posal <br /> ❑ ❑ 7. Bu ing with 2"of Cover J� <br /> ❑ ❑ 8. Aroved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation )lector control <br /> ❑ ❑ 10. Domestic FI <br /> 11 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. HeavyPopulation <br /> Structure Operation FeedingMater <br /> ❑ ❑ 18. WaterTrou hs <br /> El 1119. Cups or Bowls ' <br /> El 20. Food Storage <br /> Strut re Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings '41 <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation !�W!ater Wel <br /> ❑ 1. ell Construction "- f rr r f- <br /> nnection <br /> Structure operat Floo <br /> ❑ ❑ roperly Graded to Sewer <br /> ❑ ❑ 4. Drain ' <br /> ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> L=9%ning Frequency <br /> Structure Operaugel Walls <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ . glwning Frequency <br /> Structure Operation ages <br /> 17 <br /> ❑ ❑ ondition <br /> 1 on <br /> Structure Operation ood <br /> ❑ ❑ -t--'r-storage <br /> 11 ERW 13. WwztWarmin- <br /> structure opera nimal Dis <br /> ❑ emoval from Premises <br /> ❑ EV15. Othff <br /> Structure Operation -ge-wagegispesg- <br /> El . Se tic Sy§tem <br /> ❑ 17. Sewer <br /> structure Opedti bies vaccinatiqiP RVCJIVE (NSP o <br /> ❑ tate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />