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o�qury c <br /> ,:.�...o SAN JOAQUIN COUNTY <br /> y< 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 /> �rFORa ® �s <br /> VECTOR CON 1g®R L INSPECTION FORM <br /> 11 DBA INSPECTION DATE <br /> Structure Operation /4JJL16rd� 11 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 5 <br /> Structure Operation Manure Management OWNER/ PERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking V d C. C '131-6992 <br /> ❑ ❑ 1 4. Concrete Tanks INS TION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning Liq-S y <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 id, <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises AA f <br /> Structure NOperation Vector Control <br /> ❑ 10. Domestic FI11. Fannia FI❑ 12. Larvae❑ 13. Pu ae <br /> ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population / . o <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 <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> MMEMSEEMEM <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> 13 mv- ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. SmootIvCleanable <br /> ❑ El 6. Covin <br /> 11 El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Fre uenc <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11 11. Sanitation <br /> Structure Operation Food <br /> ❑ A k- ❑ 12. Storage <br /> 13. insectivermin <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 <br /> Structure Oper86on Rabies Vaccination RECEIV B INSPE TOR <br /> ❑ ❑ 18. Certificate on Premises r <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page f of l <br />