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SAN JOAQUIN COUNTY <br />� .� •.oma <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street Stockton, CA 95202-3029 <br />• c:, .e: a�� . Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /><<FOR <br />VECTOR CONTROL INSPECTION FORM <br />Structure <br />Operation <br />DBA ✓--% <br />i ^ <br />INSPEC ON DATE <br />t %d <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />21d 7 <br />RE -INSPECTION DATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Managmytent <br />OWNER/OPERATOR <br />/PHONE <br />! v)y rf17S'm <br />1:1 E33. Spreading and Asking <br />❑ <br />❑ <br />4. Concrete Ta s <br />INSP CTION TYPE <br />PROGRAM ELEMENT <br />RECORDID <br />❑ 1 5. Lagooning <br />❑ <br />❑ <br />6. Composti g <br />The items below represent code violations and must be corrected: <br />structure <br />operation <br />Bird Disp6sai <br />! <br />❑ ❑ 7. BuryirA with 2" of Cover <br />❑ <br />❑ <br />8. Ap ved Concrete Tank <br />s <br />❑ ❑ 9. R oval from Premises <br />Structure <br />Operation <br />Ve or Control <br />❑ ❑ IV Domestic FI <br />Fannia FI <br />�- <br />' <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Li ht Population <br />❑ 16. Moderate Population <br />❑ <br />17. Heavy Population <br />Structure O eration Feeding/Water <br />1:1 <br />El <br />18. Water Trou hs <br />1:1 El 19. Cups or Bowls <br />El <br />20. Food Storage <br />structu Operation Houses <br />❑ <br />❑ <br />21. Floors <br />❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency <br />Structure <br />Operation <br />Water Well <br />® �, <br />❑ ❑ OT 1. Well Construction <br />2. Cross Connection <br />Structure Operation Floors <br />11 <br />3. Properly Graded to Sewer <br />'� P <br />-❑ <br />❑ ❑ 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />6. Covin <br />El <br />0 <br />7. Cleaning Frequency <br />Structure Operation Walls <br />❑ <br />❑ <br />8. Smooth/Cleanable <br />9. CleaningFrequency <br />❑p0perration <br />Structure <br />Cages <br />�'El <br />❑10. ConditionIva <br />11. Sanitation <br />Structure Food <br />❑ <br />12. Storage <br />13. Insect/Vermin <br />Structure <br />Operation <br />Animal Dis oral <br />❑ ❑ 0 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Structure operation Sewage Disposal <br />❑ <br />❑ 0 <br />Lr6-. Se tic System <br />❑ ❑ 17. Sewer <br />Structure <br />Operhtion <br />Rabies Vaccination <br />RECEIV BY c <br />INSPE TOR <br />'e, <br />❑ ❑ 18. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 12/04/08 <br />Page f of <br />