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0 SAN JOAQUIN COUNTY 0 <br /> _ 2 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 /> �/PORN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA (NSP C ON DATE <br /> Structure Operation Water Well f)mfa) <br /> ❑ ❑ 1. Well Construction PREMISE ADDRES RE-IN PECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure operation Manure Management OWNER/OPERATOR PH614E <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION Twat PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning yd y s V <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover �7 <br /> ❑ ❑ 1 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11 11. Fannia FI <br /> 11 ❑ 12. Larvae 6 <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult "` t a <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 Bowls <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc ) <br /> MMMEEMEMEMEM <br /> Cr % <br /> Structure operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure operation Floors <br /> ❑ ❑ 3. ProperlyGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El El 6. Covin <br /> ❑ 0 7. Cleaning Frequency <br /> Structure Operation Walls <S' <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequencyf <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11 11. Sanitation <br /> Structure Operation Food 6snz" <br /> ❑ ❑ 1 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 �- e4v,j 9 <br /> Structure Operation Rabies Vaccination RECEIV D ' INSPE OR <br /> ❑ ❑ 18. Certificate on Premises �(r <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of,,[_ <br />