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SAN JOAQUIN COUNTY <br /> i ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> •c� :. :.:;�. Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �1FORa <br /> 0 W03&7 VECTOR CONTROL INSPECTION FORM <br /> MINIMENIM 5V DBA IN E J N[j <br /> Structure Operation / / <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Conn n J571 ) VV ` <br /> Structure Operation Manure Man ement OW R/OPERATOR 9 PHONE <br /> I <br /> ❑ E] 3. Spreadi and Disking <br /> ❑ ❑ 4. Concr Tanks INS P TION Ty I, PROGRAM ELEMENT RECORD ID <br /> 11 ❑ 5. Lag ning <br /> ❑ ❑ 6. c 96posting The items below represent code violations and must be corrected: <br /> Structure Operation Bir Disposal <br /> ❑ ❑ 7 Bu in with 2"of Cover <br /> ❑ ❑ A. ADDroved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operatio Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11 11. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae e <br /> ❑ ❑ 14. Adult t <br /> El 15. Light Population <br /> ❑ ❑ 16. Moderate Population l/ r <br /> ❑ ❑ 17. Heavy Population f e a <br /> stn, re Operation FeedinglWater • '• n <br /> ❑ 18. Water Troughs <br /> ❑ 19. Cups or Bowls <br /> 20. Food Storage "� C <br /> Structure Operation Houses ,)r r <br /> ❑ ❑ 21. Floors c t <br /> 11 13 22. Walls/Ceilings /h <br /> 11 El 23. Cleanin Fre uenc <br /> 0 <br /> Structure Operati a <br /> ❑ ❑ all Construction 1 wasl�- CUSP i9sed Cf <br /> 2. Cross Connection a f 4 <br /> Struchr ration n <br /> 11 3: ed.to Sewer <br /> ❑ ❑ Drain e <br /> ❑ ❑ 5. Smooth/Cieanabie ° !� <br /> 6. Covin h <br /> 11 El 1 7. Cleaning Frequency <br /> Structure Operation S <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9 ing Frequency <br /> StructureOperation Ca <br /> El El q. Condition <br /> 11. itation <br /> Structure Operation o0 <br /> [5 ❑ tura e <br /> 11 13. Ins ermin <br /> Structure Operation IS 2Sai <br /> ❑ ❑ errwval from Premises <br /> ❑ ❑ 15. Other <br /> S Operation s Disposalystc>�, <br /> 0. <br /> ❑ 17 e em akkt016 166 <br /> ` / <br /> Structu Operation S Vaccination R E INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises ,f <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page-of_ <br />