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SAN JOAQUIN COUNTY <br /> � .�,et=s•••.o <br /> zy ENVIRONMENTAL HEALTH DEPARTMENT <br /> ..� 600 East Main Street Stockton, CA 95202-3029 <br /> c� :. .:.:.;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �/FORS <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> StructureOperation $ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPEC ON DATE <br /> ❑ ❑ 2. Cross-connection <br /> Structure Operation Manure Management OWNER/OPERATOR j PHONE <br /> ❑ ❑ 1 3. Spreading and Disking C tlaz-- <br /> ❑ ❑ 4. Concrete Tanks INSPE TION TYPE PROG ELEMENT RECORD ID <br /> 1:1 ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 1 7. Burying with 2"of Cover % B: <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control / <br /> ❑ ❑ 10. Domestic Fly <br /> El 11. Fannia Fly <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult - <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or BoWs -c <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings ° Q faQndr <br /> ❑ ❑ 23. Cleaning Frequency <br /> j2kZAih-A+ <br /> Y t w <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction S . <br /> 2. Cross Connectio <br /> Structure Operation Floors <br /> 3. ProerlGra to Sewer <br /> ❑ ❑ 4. Drain Z 5 <br /> ❑ ❑ 5. Smootbkieanabie <br /> 6. CovirA <br /> ❑ 0 7. CiVning Frequency <br /> Structure Operation Wal s C <br /> ❑ ❑ 8. mooth/Cleanable <br /> ❑ ❑ V Cleaning Frequency <br /> Structure Operation ages <br /> ❑ ❑ 10. Condition waf'ke- <br /> 0 El <br /> 11. Sanitation <br /> Structure OperatOn Food <br /> ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure eretion Animal Dis al <br /> ❑ ❑ 14. Removal from Premises e� <br /> ❑ ❑ 15. Other <br /> Structu Operation Sewage Disposal <br /> ❑ 16. Septic System <br /> ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEMED B f INSPE <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Pager of <br />