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f <br /> s . <br /> SAN JOAQUIN COUNTY <br /> w 'X 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 /> VECTOR CONTROL INSPECTION FORM <br /> DBA s INSPECTION DATE <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 111 eel <br /> Structure Operation Manure Managejnent O ER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and isking � 3 V-/S/' <br /> ❑ ❑ 4. Concrete Ta/Ks INS ECTION TYPE PROGRAM ELEMENT RE ORD ID <br /> ❑ ❑ 5. Lagooning J� <br /> ❑ ❑ 6. Compos' g The items below represent code violations and must be corrected: <br /> Structure Operation Bird Di osal <br /> ❑ ❑ 7. Bu with 2"of over 1o2. <br /> ❑ ❑ 8. A roved Concrete Tank <br /> ❑ ❑ 9. emoval from Premises s <br /> Structure Operation V ctor Control <br /> ❑ ❑ 0. Domestic FI <br /> 11 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ 15. Light Population f <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls r�7 41-A 12-11 y <br /> 'le-j Ill <br /> 20. Food Storage <br /> Stru re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fr uenc <br /> Structure Operation I Water Well <br /> ❑ ❑ 1. Well Constriction <br /> 2. Cross Connection <br /> Structure Operation Floors �� "e- <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 11 <br /> 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El 6. Covin <br /> 7. Cleaning Frequency �- oe <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation I Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. InsecWermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> El 17. Sewer <br /> Structure Operation Rabies Vaccination RECE INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 �/ <br /> Page_of_ <br />