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�► <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> �IFORN <br /> VECTOR CONTROL INSPECTION FORM <br /> 1111110111 DBA l I 'tf NSPECTIONeDATE <br /> StructureOperation ' ,� 4.'/"J'r lC <br /> / ,rr•%<'I 1/ /q1 �a <br /> ❑ ❑ 1. Well Construction PREMISE DRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection',.1 % �� iT G /' ;I:�? <br /> Structure Operation Manure management OWNERIOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking z 7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE VPROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning d < <br /> /i <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal �T <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 0. Domestic FI �y /1 <br /> "1i I C "f W E� IY..�./ ....t. <br /> 11. annia FI <br /> ❑ ❑ 12. Larvae Lr lc�. �^ r- a a, �� r , r <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑, 15. Light Population /-L <br /> < T`C <br /> ❑ 16. Moderate Population c' ✓C"Gt s %< <br /> ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls - F .9 y�' G G'�CK4 .r rr. 7ri "'),-c <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors - <br /> ❑ ❑ 1 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure operation Water Well <br /> El El 1. Well Construction / (' <br /> ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El 1:1 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 /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises J <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 3 <br /> Page 1 of <br /> tf"�` <br />