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r/ <br /> ot'aut" SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> •�` ,._..:.r,:.�� Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> �rFORN <br /> VECTOR CONTROL INSPECTION FORM <br /> MENEENNIM DRA INSPECTION PATE <br /> Structure Operation Water Mll / <br /> ❑ ❑ 1. Well Construction PREMISE A�D^DRESS RE-INSPECTION DATE <br /> 11 El 2. Cross-Connection / ?70S- <br /> J <br /> Structure Operation Manure Mana emen O ERlOPERATOR VPHONE t� <br /> E] ❑ 3. Spreading and Diski r l` I -3` Y.Z <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRil-AM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning T r-- ,? <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposof <br /> ❑ ❑ 7. Bu 'na wA 2"of Cover o <br /> ❑ ❑ 8. Approve6 Concrete an o <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation Vect Control <br /> ❑ ❑ 10. omestic FI <br /> El 1:1 11 Fannia FI r ®h <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structureration Feeding/Water <br /> 1:1 El 18. WnterTrou hs a <br /> El El 19. Cups or Bowls 3 P r <br /> 171 20. Food Storage <br /> Stru Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Stricture Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. ProerlGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. SmootWCleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 17 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> El El 13. Insect/Vermin <br /> Structure Operation Animal Dis anal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic SNstern <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED B INSP <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page /Of <br />