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SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • c��:. N;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �IFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION ATE <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection f'7-5-1 <br /> Structure Operation Manure Mana erne t OWNERVOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Di ing C I.;7-of ?3 I <br /> GRAM ELEMENT RECORD ID <br /> 1:1 ❑ 4. Concrete Tank INSPECTION TYPE PRO <br /> 11 El 5. Lagooning 0§� 7 <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. BuryinVith 2"of Cover ° <br /> ❑ ❑ 8. A r ved Concrete Tank <br /> ❑ ❑ 9. R oval from Premises <br /> Structure Operation Vegfor Control <br /> ❑ ❑ 1 Domestic FI <br /> 11 1. Fannia FI <br /> ❑ ❑ Y12. Larvae ® 1." m <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Pop ulation <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Aeration Feeding/Water <br /> ❑ ❑ 18. Water Troughs r _ <br /> ❑ ❑ 19. Cups or Bowls e <br /> Mre <br /> 20. Food Stora e <br /> Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> 7j <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection _ <br /> Structure operation Floors ® �C <br /> ❑ ❑ nb,3. Pro ed Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ 1715. Smooth/Cleanable <br /> ❑ D 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 04 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> or <br /> ❑ ❑ 4. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ . Septic System <br /> ❑ ❑ 17. Sewer <br /> StructureOperktion Rabies Vaccination RE INSPECTOR <br /> ❑ ❑ . Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 17/04/08 <br /> Page of <br />