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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> w <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAINSPEC NDA <br /> Structure Operation I 124,411:tck <br /> rL ' <br /> ❑ 1 I C truction PREMISE ADDRESS V RE-INSPECTION DATE <br /> ❑ . Cross-Connection a <br /> Structur Operation Manure management OWNER/OPERATOR 44 PHONE <br /> ❑ C] 3. Spreading and Disking I� r� ' V <br /> IVIA <br /> ❑ EJA 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> E] 5. Lagooning R. <br /> ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure ti Bird Disposal <br /> ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ 9. Removal from Premises f <br /> Structure OpeotionN Vector Control <br /> ❑ 10. Domestic Fl net cLr1 -fnr) <br /> 1. Fannia Fly I <br /> ❑ ❑ 1 Larvae 6L hL r r <br /> ❑ ❑ 13. Pu ae ��y �� e w <br /> ❑ ❑ 14. dull t <br /> ❑ ❑ 15. I-Nqht Population <br /> 1:1El16. Moclvrate Population tz <br /> 11 ❑ 17. Heav o ulation o <br /> Shucturey Operation Feedin ter N OTG s <br /> ❑ ❑ 1 18. Water Trou s <br /> ❑ ❑ 1 19. Cups or Bowls j y <br /> Structure operation Houses Stora a t I, 1 t- 1 t <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings kept ir <br /> ❑ ❑ 23. CleaninR Fre uenc <br /> Structure Operation Water Well a <br /> ❑ ❑ nstruction ✓ Gtr f n �. <br /> 2. Cross Connection <br /> Structu tion Floors <br /> . Properly Graded to Sewer <br /> 4. Drain <br /> 5. Smooth/Cleanable Y <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Struc Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequen c2fi nt <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> El 11. Sanitation E <br /> Structure Operation Food r <br /> ❑ ❑ 12. Storage <br /> El n 13. Insect/Vermin c zs <br /> Structure Operation Animal DIS O al <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Se Disposal <br /> ❑ ❑ tem , <br /> ❑ ❑ 17. Sewer l B 1 r <br /> Structure Oper9tion Rabies Vaccination RECEIVED BY INSP OR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />