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aQt,i" SAN JOAQUIN COUNTY <br /> 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> O��IFORa`P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> R[�' / INSPECTIONDATE <br /> Structure Operation .J;t l��G'� /�Q!!t`4 i.�C2.�',.:!E'y� � j�P 7! 711 0 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESeS' RE-INSPECTION DATE <br /> I-] 1-] 2. Cross-Connection 1 9 70;3 /f/ pe. <br /> Structure Operation Manure Management OWYNERIOPERATOR PHONE <br /> 1:1 El3. Spreading and Disking ez,^t e?4zea',f- 4r � st.�� l�A' ),27W j Y <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORDID_ <br /> ❑ ❑ 5. Lagooning3C4. LQ° /A ,a <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal' // r <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> ' c^T'rZaC 1��, ('cts.i�j 'z <br /> ❑ ❑ 8. Approved Concrete Tank ; <br /> ❑ ❑ 9. Removal from Premises C�Qwt vr'> `t.p7T <br /> Structure Operation Vector Control <br /> ❑ ❑ 1 10. Domestic FI <br /> El El 1 11. Fannia FI <br /> f 61 k.G-G �:i-!� i!'�.e Q-Ii r_'.?1.I.eF! � •'r G•� <br /> ❑ ❑ 12. Larvae 1 <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population �� F!''�� `,-�271'cT ..C. .�it �4�✓�✓�r'� c:.''n�7`�`'-r.�`2rt-I'�. <br /> ❑ ❑ 16. Moderate Population O ti <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs t <br /> ❑ ❑ 19. Cups or Bowlsctt G-3 ,. ' .rt.A h 1 L 1 t.{r Gxt✓l r d x / r i.e x.4 ' <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequenc <br /> Structure operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 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. InsectNermin <br /> Structure Operation Animal Disposal <br /> Prp, <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY ^ INSPECTOR <br /> ❑ El18. Certificate on Premises ✓'.• A' 1! . ' f >':> <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />