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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 /> �rFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> loll=WMM 11111111111111M DBA - INSPECTION DATE <br /> Structure Operation Water Well /O/S" // <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS, / RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3.2.2/ 7 & C• L_c�. <br /> Structure Operation Manure Mana @ ent OWNER/ PERATOR PHONE <br /> ❑ ❑ 3. Spreading and isking ';�i 1 - A" <br /> ❑ ❑ 1 4. Concrete Ta s INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning qy G. 7 <br /> ❑ ❑ 6. Composti g The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis sal <br /> ❑ ❑ 7. B.rvinl.ith 2"of Cover t <br /> ❑ ❑ 8. Apprived Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve r Control <br /> ❑ ❑ 10 Domestic FI <br /> _14. Fannia FI <br /> ❑ ❑ A2. Larvae <br /> ❑ ❑ f 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure- o ration FeedingNVater <br /> ❑ ❑ 18. Water Troughs IT <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structur Operation Houses <br /> ❑ 21. Floors <br /> 1:322. Walls/Ceilings _ <br /> ❑ ❑ 1 23. Cleaning Fre uenc <br /> Structure Operation ater - <br /> ❑ ❑ 1. Well Construction <br /> Cross Connection <br /> Structure Operatio FlOo <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain e'� <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operation alis <br /> ❑ CIA) <br /> 8. Smooth/Cleanable <br /> ❑ ❑ 9. nin Frequency <br /> Structure Operatio C eS <br /> ❑ ❑ ndition <br /> 13 nitation <br /> Structure Operation/'Food <br /> ❑ tora e <br /> 13. In <br /> Structure Operation inial Dis al <br /> ❑ emoval from Premises <br /> ❑ 15. <br /> Structure Operation ewage Diaposal <br /> ❑ 6. Septic System <br /> ❑ ❑ 17 <br /> Structure Ope ti Rabies Vaccinatio RECEIVED BrkVINSP C OR <br /> ❑ i tate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />