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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> . c��:,_• --:;c . Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA , f®/�✓ INS N DAT <br /> Structure O eratbn / PetV`s/ <br /> ❑ ❑ 1. Well Construction/ PREMISE DRESS ` REAN PECTIO DATE <br /> 11 El 2. Cross-Connect' n <br /> Structure Operation Manure Man ement OW Rd <br /> OP RATQR rPHOVE <br /> ❑ ❑ 3. Spreading Ad DiskingDUA )aVV '/r <br /> ❑ ❑ 4. Concret anks ECTI N TYPE PROGRAM ELEMENT RD ID <br /> ❑ ❑ 5. Lagoo ng V <br /> 11 ❑ 6. Co sting The items below repres nt code violations and must a corrected: <br /> Structure Operation Bird isposal <br /> ❑ ❑ 7.jifurying with 2"of Cover <br /> ❑ ❑ . Approved Concrete Tank >® G <br /> ❑ ❑ 9. Removal from Premises <br /> Structure operationt Vector Control r e <br /> ❑ 10. Domestic FI �I <br /> El 11. Fannia FI <br /> ❑ 1 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population o <br /> ❑ 17. Heavv Population <br /> S cture Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs ; <br /> ❑ ❑ 19. Cups or Bowlswe® I <br /> n WOO( <br /> 20. Food Storage t c <br /> Structure Operation Houses „ <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 1 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc t <br /> + �' C�Uyred Oadu;fiers , <br /> Structure Operation <br /> ❑ ❑ coon <br /> 2. Cross Connection t <br /> Structu Operation I00 <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> El El g Frequency <br /> Structure Operatio WaI1S <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ 9. re uenc <br /> Structure Operatio Ca <br /> ❑ ❑ 10. Condition <br /> tation <br /> Structure Operation I Food <br /> ❑ ❑ 12. Storage <br /> 13 <br /> Structure Operation Mmal Disposal <br /> ❑ ❑ emoval from Premises <br /> ❑ ❑ 15 <br /> PE <br /> Sewage Disposal <br /> 16. Se ticS tem 7(00 Rabies V cination RE IV BY INSPECTOR <br /> 18. Certificate on Premises <br /> VECTOR NTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of_ <br />