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SAN JOAQUIN COUNTY 1@1 <br /> _ s ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • q:.- .: ;�. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �lFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> moommem DBA INSPECTION DATE <br /> Structure Operation t <br /> ❑ 1. Well Construction PREMIS DR 4f RE-IN PECT16N DATE <br /> ❑ 2. Cross-Connecti n ` 42y <br /> strict Operation Manure Mana ement OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading d Disking t/ <br /> 71 <br /> ❑ ❑ 4. Concrete fanks INS PEC ON E PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 1 5. Lagoonigig 41 41S I <br /> ❑ ❑ 6. Com ting The Items below represent code violations and must be corrected: <br /> Structure enation Bird D' posal <br /> ❑ r,1 7. Budinq with 2"of Cover <br /> ❑ 8. Aloroved Concrete Tank <br /> ❑ 9.Aemoval from Premises <br /> Structure operati V/ ctor control <br /> ❑ ❑ 0. Domestic FI <br /> 11. Fannia FI q <br /> ❑ ❑ 12. Larvae / <br /> ❑ ❑ V. Pupae <br /> ❑ EV 1 Adult <br /> ❑ 15. i ht Population <br /> ❑ 16. erate Population r <br /> 4442 IV CI-A-b- <br /> 1:1 ❑ 17. He\vy Population <br /> Structure Operation Feedinblwater <br /> ❑ ❑ 18. Water rou hs <br /> ❑ 19. Cups or owls d <br /> El 20. Food Sto e <br /> cture Operation Houses e <br /> ❑ ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> nomommmmmm 41.) <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 1:1 El 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. ProerlGraded to Sewer <br /> ❑ ❑ 4. Drain i f <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 1 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. insecWermin <br /> Structure Operation Animal Dislporal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED INSPECTOW <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page f of <br />