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0' SAN JOAQUIN COUNTY 0 <br /> o � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> •%� P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> tFOR�� <br /> VECTOR CONTROL INSPECTION FORM <br /> Emm DBA INSPEC <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PRE IS R 'RE-ASPECTIbN DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management O EOPERA R PHONE <br /> ❑ ❑ 3. Spreading and Disking b6o 61-%y 7 <br /> ❑ ❑ 4. Concrete Tanks NSP TION TyFtE PROGRAM ELEMEN CORD ID <br /> ❑ 5. Lagooning (� <br /> ❑ ❑ 6. composting The items below represent code violations d M11-61- <br /> Structure <br /> ustbeStructure 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. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population "yl <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water , <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls >� <br /> El 0 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings t/1OC rnAAAejA <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> 7mA <br /> Operation Water Well <br /> 1. Well Construction <br /> 2. Cross Connection Operation Floors <br /> 3. Proeri Graded to Sewer <br /> ❑ 4. Drain❑ 5. Smooth/Cleanable <br /> 1:1 El 6. C vin <br /> 7. 9ILaning Frequency <br /> Structure Operation I Vfalls <br /> ❑ ❑ 8. Smooth/Cleanable } <br /> ❑ ❑ 9. Cleaning Frequency -L <br /> Structure Op tiqfi Cages <br /> ❑ 10. Condition e g <br /> EI M 11. Sanitation <br /> Structure OpqFat!bv Food <br /> ❑ 12. Storage <br /> 13. Insect/Vermin loew- 4&�&c flj_� <br /> Structure Operation imal Dis oral I 49L <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ 1115. Itr <br /> IJ <br /> Structure j Operation Sewage Disposal <br /> ❑ 1 ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEI D INS R <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page Of <br />