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SAN JOAQUIN COUNTY <br /> 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 /> �rFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> mommmimm DBACC INSP CTION DATE <br /> Structure enation G k S /IS-/// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection ;23 7 Lid <br /> Structure Operation Manure Management ER/OPERATOR PHONE 401 <br /> ❑ ❑ 3. Spreading and DiskingMaAjim ?- 2. <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. LagooningYVA,"-7- q 0 <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> stricture Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover ` <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> structure operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11 0 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult S2, <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population C kiaen " <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water 4c V4 S <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ I ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cieanin aFr uenc <br /> 9 <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Prorl Graded to Sewer <br /> ❑ ❑ 4. Drain S ®`f' kUze,14 401 <br /> ❑ ❑ 5. Smooth/Cleanabie <br /> 6. Covin2 ra <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable _ <br /> ❑ ❑ 9. Cleaning Frequency 5 <br /> Structure Operation Cages <br /> ❑ ❑ 1 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> C3 ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> structure Operition Rabies Vaccination RECE D BY IN EC <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />