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SAN JOAQUIN COUNTY 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • :_- ;;•N;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<F O R <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC71 N DATE <br /> Structure Operation - /0/"//// <br /> ❑ ❑ 1. Well Construction PREMISE AD ESS _ RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-connection /,� / _S7 ' <br /> Structure Operation Manure Mana ern nt OWNERlOPERATOR le PHONE <br /> ❑ ❑ 1 3. Spreading and D' king / q)4 - . .9-S <br /> ❑ ❑ 4. Concrete Tank INSP cTiON TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning "' a <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. Bu in with 2"of Cover ® C r <br /> ❑ ❑ 8. Appr ed Concrete Tank <br /> 11El9. Re oval from Premises r <br /> Structure Operation Vecj6r Control <br /> ❑ ❑ 10 Domestic FI <br /> El 14. Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure erasion FeedingNVater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bovis T 07 <br /> 20. Food Storage <br /> Struc a Operation Houses <br /> ❑ 21. Floors �� � <br /> 1122. Walls/Ceilin s ar ��� <br /> 1] 1323. Cleanina Fr uenc <br /> Structure Operation ater W <br /> 13 ❑ 1. Well Construction 7, <br /> nnection <br /> Strtucture Operatio I ��" <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin -�° J" 7-7°e- <br /> �a <br /> El <br /> 7._gl!12ning Frequency <br /> Structure Operation Walls <br /> ❑ 11(0/ 8. Smooth/Cleanable <br /> ❑ ❑ Frequency <br /> structure operation Cages <br /> ❑ ❑ 10. Condition <br /> El 02. Storage <br /> ation <br /> Structure 90permation <br /> ❑ reninstructure Dis a❑ m Premises <br /> ❑ <br /> Structure Operation ewage Disposal <br /> ❑ ❑ 116. SepticSystem <br /> ❑ ❑ 17. <br /> Structure operation Rabies Vaccinatio REC VE INSP C OR <br /> ❑ ❑ 8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />