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JAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • c� :.- :P. Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwW.sjgov.orgiehd <br /> �rFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECT ON D <br /> ® <br /> Structure Operation l <br /> ❑ ❑ 1. Well Construction PREMISE ADDR SS V RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3 / <br /> Structure Operation Manure Mana eme OW ER/OPERATOR PHONE <br /> 11 ❑ 3. Spreading and Dis ng 6"e' 490VOSI <br /> ❑ ❑ 4. Concrete Tanks INS ECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning ��5� .3 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo al <br /> ❑ ❑ 7. Bu in ith 2"of Cover <br /> ❑ ❑ 8. Apprqed Concrete Tank l <br /> ❑ ❑ 9. Re oval from Premises ' <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> 1 f Fannia FI <br /> ❑ ❑ 2. Larvae t ?T I <br /> ❑ ❑ 113. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heay Population <br /> Structure Op tion Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 1 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water W 1 <br /> ❑ ❑ 1. Well Construction v® <br /> El Li W Connection <br /> Structure Operation F16 <br /> ❑ -S.-ProperlyGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7,gegning Frequency <br /> Structure Operation aIle <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ ,jeXing Frequency <br /> Structure Operation "Cage <br /> ❑ ❑ ndition <br /> itation <br /> Structure Operatio FoW <br /> ❑ ❑ 12. Storage <br /> 13. in <br /> Structure Operation AgAmal Dis sa <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation I Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. S <br /> Structure Operiitio hies Vaccina RE ED BY INS EC R <br /> ❑ ❑ 18. Certificate on Premise61s <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page / of <br />