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caul SAN JOAQUIN COUNTY <br /> _ y 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 /> 4�r=2i Rt' <br /> VECTOR CONTROL INSPECTION FORM <br /> womwommilmm DBA ® INSPECT ON DATE <br /> Structure Operation //2 e �, <br /> ❑ ❑ eley <br /> 1. Well Constru ' n PREMISE DRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Conn 'on <br /> Structure Operation Manure Man4dgelment R/OPERAT R PHONE <br /> ❑ ❑ 3. Spreading ind Disking Ir �) 3 -11 <br /> ❑ ❑ 4. Concrete anks INSP CTION TYPE V PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooni g 4wf 05-IS-:2- s <br /> ❑ ❑ 6. Comp ting The items below represent code violations and must be corrected: <br /> Structure Operation Bird D' posal <br /> ❑ ❑ 7. Bu4inq with 2"of over d <br /> ❑ ❑ 8. Alp.d Concrete Tank <br /> ❑ ❑ 9.Aemovai from Premises <br /> Structure Operation ctor Control <br /> ❑ ❑ AO. Domestic FI <br /> 11 f 11. Fannia FI <br /> ❑ ❑ 12. Larvae ' �A <br /> ❑ ❑ 13. upae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Aeration FeedingMater <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> 0 El 20. Food Storage <br /> Structu Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1 1. Well Construction a <br /> 2. Cross Connection Ike <br /> Structure Operation Floors /7 <br /> ❑ 3. Proerl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> _L Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El 0 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ I ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> StructureOper2tion I Rabies Vaccination RECEI, s N SP T R , <br /> El 1:118. Certificate on Premises " L ^P <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> P ge of <br />