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)O�4"'" SAN JOA I COUNTY IN <br /> 'CO <br /> y< ENVIRONMENTAL HEALTH DEPARTMENT <br /> : .,.A 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> �tFotizN <br /> VECTOR CONTROL INSPECTION FORM <br /> MEEMEMEM DOA INSPECTIO DATE <br /> Structure eration <br /> ❑ ❑ 1. Well Construction PRESE�ADDRESS REANSP CTION ATE <br /> ❑ [12. Cross-Connecti <br /> 0i�- /V. ?�& <br /> Structure Operation Manure Managifirnent ER/OPE TOR PHONE <br /> ❑ ❑ 3. Spreading a96 Disking lam, <br /> ❑ ❑ 4. Concrete nks PR G CORD <br /> ❑ 5. gooni❑ C <br /> ❑ ❑ 6. compg4ting The items below represent code violations and must be corrected: <br /> Structure Operation Bird D' posal <br /> ❑ ❑ 7. B ing with 2-of over <br /> ❑ ❑ 8. roved Concrete Tankc <br /> ❑ ❑ 9./Removal from Premises / ` < Ut ii(JG <br /> Structure Operation Vbctor Control <br /> ❑ ❑ 0. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Po ulation <br /> Structure Operation Feeding/Water Rable S llax-c® ® 1 <br /> 4,0;* <br /> ❑ ❑ 18. Water Troughs @ a <br /> ❑ ❑ 19. Cups or Bowls . <br /> 20. Food Storage <br /> S tura Operation Houses <br /> ❑ ❑ 21. Floors k- <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ El23. Cleaning Frequency <br /> Structure peration ate,,Well <br /> ❑ ❑ e Construction <br /> 1:12. Connection g <br /> Structure Operation IOOrS No y 1 <br /> ❑ ❑ erlGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> El 7.,94ening Frequency <br /> Structure Operation <br /> ❑ ❑ month/Cleanable <br /> ❑ 9. eani Frequency <br /> Structure Operation G <br /> 11 . Co <br /> 10ndition <br /> nitation <br /> Structure Operation F 9 <br /> El ❑ torn e <br /> 13. Insect/Vermin <br /> Structure Operation Animal Dis oSal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 1 tem e <br /> ❑ El r <br /> Structure Operation *AqipaVaccination RECEIVED BY SPEC R <br /> El 11 18. Certificate on Premises ` <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page jof <br />