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s= <br /> quty <br /> ,off„�ao SAN JOAQUIN COUNTY 0 <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 /> �IFORN ® ® p� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAINSPECTION DATE <br /> Structure Operation -# <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection / O <br /> Structure Operation Manure Mana a ent OWN R/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and isking f ( ) �-.3/ <br /> ❑ ❑ 4. Concrete Ta s INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning j(-/ <br /> ❑ ❑ 6. Composti g The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis sal _ <br /> ❑ ❑ 7. Bu i with 2-of Cover <br /> ❑ ❑ 8. A oved Concrete Tank <br /> r <br /> ❑ ❑ 9. moval from Premises <br /> Structure Operation V or Control Of <br /> ❑ ❑ A. Domestic FI <br /> 0 El 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑❑❑ v0p. <br /> 13. Pupae e <br /> El 0/ 14. Adult <br /> 15. Light P <br /> o ulation <br /> 16. Moderate Population <br /> t <br /> ion s . <br /> ❑ 1:117. HeavyPopulation <br /> Structure ® ®� <br /> Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls i yA, e <br /> 20. Food Storage <br /> St.T. Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross ConnectionWW 44� <br /> ` sf <br /> Structure Operation Floors <br /> ❑ ❑ 3. Proed Graded to Sewer <br /> ❑ 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> El 0 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Dis anal <br /> ❑ ❑ 14. Removal from Premises <br /> El ❑VT 15. Other <br /> Structure Operation SewAqqjQLsposaI <br /> ❑ e tic SyAem <br /> ❑ ❑ <br /> 17- wer <br /> Structure Operation Rabies Vaccination RECEIVED Y IN OR <br /> ❑ 18. Certificate on Premises P <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page , of <br />