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otaut"' SAN JOAQUIN COUNTY <br /> 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 /> 107- 06003LID <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSP C N DA12 <br /> Structure Operation �' <br /> ❑ ❑ 1. Well Construction I PREMISE ADDREREANSPECTION DATE <br /> ❑ ❑ 2. Cross-Connectio ' 10 /� r <br /> Structure Operation Manure Manag ent OWNS OPE TOR el HONE <br /> 11 ❑ 3. Spreading an Disking Lq - <br /> ❑ ❑ 4. Concrete T ks INSPECTI TYPE 4 PROGRAM ELEM NT RECORD ID <br /> 14 <br /> ❑ 5. Lagooni U7 <br /> ❑ ❑ 6. Compoting The items below represent code violations and must be corrected: <br /> Stricture Operation Bird D' posal c <br /> El 117. B in with 2"of Coverpe' kkv aAd /V l <br /> ❑ ❑ 8. Aproved Concrete Tank , c <br /> ❑ ❑ 9/Removal from Premisesnak 'S 141tkjrvq <br /> Structure Operation /lector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae s <br /> TVQ" 5;�)� <br /> ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ ❑ 15. Light Population c c r <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure/ Operation FeedingANater C& <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage N <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors t <br /> 1:1El22. Walls/Ceilin s Car <br /> ❑ 1 ❑ 23. Cleanin Fr uenc <br /> Structure Operation Well a <br /> 13 11nstruction VIM I �* <br /> 2. Cross Connection c < <br /> structure Operation FIeloo d <br /> ❑ 1 §=4!0e-dX Graded to Sewer <br /> ❑ 4. <br /> ❑ ❑ 5. th/Cleanable P <br /> ❑ 6. Covin ` � 1 <br /> El 7.!Z[aaffrh2 Frequencyc <br /> Structure Rperation Wail <br /> ❑ 8. Cleanable <br /> ❑ ❑ n <br /> Frequency <br /> Structure Operation Cages <br /> ❑ 1 . Condi n <br /> SanitaAn <br /> Structure Operation F <br /> ❑ ❑ Sto <br /> Z. ermin <br /> Structure Operation inial DIS oral <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sew Disposal <br /> ❑ ❑ 6. tem c <br /> IY61-1 96 <br /> ❑ 17. Sewer <br /> Structure eration Rabies Va ' ion REC9IIVE INSPECT <br /> El 18 'fi remises MWA <br /> VECTOR C ROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page-(of <br />