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Qa`'•" SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • c��:, ;,NSP• Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> LrFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA ' INSPECTION DAT <br /> Structure operation C�d®ey - � /O 77// <br /> ❑ ❑ 1. Well Construction PREMIS ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection &2 3 a a 7 <br /> Stricture Operation Manure Managemenlif OWN oPERATO PHONE <br /> 13 3. Spreading and Diski A %) <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning - ! <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burvinqwithh of Cover ! <br /> ❑ ❑ 8. Approvedk.nrete Tank <br /> ❑ ❑ 9. Remov from Premises 7 <br /> Structure Operation vector ontrol <br /> ❑ ❑ 10. D mestic FI <br /> El 0 11. annia FI <br /> ❑ ❑ 1Z/Larvae �® <br /> ❑ ❑ Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Po ulation <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure Op tion FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 0 El20. Food Storage <br /> Structur Operation Houses <br /> ❑ 21. Floors / <br /> ❑ 1 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fr uenc <br /> Structure Operation Water <br /> ❑ *) Fc Well ConstructionEl C Connection <br /> Structure Ope❑ roped Graded toSewer❑ rain ow <br /> dr <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7 <br /> ing Frequency <br /> Structure operatio Wall ® , <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ 4Operation <br /> eanin Frequency <br /> Structure Condition <br /> El S nitation <br /> str u:turwre❑ Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Dis !sal <br /> ❑ ❑ 1 Removal from Premises <br /> ❑ I❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 66 .S-,Pntir..-1VqtA1n❑ ❑ ewerStructure OperBtioeS VaccinatioRECE VED B INP C❑ ❑ ertificate on Premises P <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page ' of <br />