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r <br /> o�4ul" 0 SAN JOA IN COUNTY '` <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Mair? Street Stockton, CA 95202-3029 <br /> 4 a�P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �IFOR <br /> fT*600 Vjyq VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC ON DA <br /> Structure Operation (/1r. <br /> ❑ ❑ 1. Well ConstructionPffMIS ADDRESS RE INSPECTION DATE <br /> C] ❑ 2. Cross-Connection G5JC�s!!l1D1 e <br /> Structure Operation Manure Management OERlOPERATOR iPHONE <br /> 11 El3. Spreading and Asking <br /> ❑ ❑ 4. Concrete Ta s 17M N,TYPE PR ELEMENT RECORD(D <br /> ❑ 5. Lagoonin LfqS <br /> ❑ ❑ 6. compo ng The items below represent code violations and must be corrected: <br /> Structure Operation Bird Di posal <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> ❑ ❑ 8. 6proved Concrete Tank a <br /> ❑ 1 ❑ Removal from Premises <br /> Structure Operation ftector Control <br /> ❑ ❑ 10. Domestic FI <br /> El 11. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ 13. Pupae r <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ ❑ 16. Moderate Population 2- <br /> ❑ ❑ 17. Heavy Population <br /> Stru re Operation Feeding/Water re, - <br /> 11 18. Water Troughs { <br /> ❑ ❑ 19. Cups or Bowls - 's <br /> El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23—Deqning Frequency <br /> Structure peration Water W011 <br /> ❑ nstruction I ? <br /> Cro Connection <br /> Structure peration FloO <br /> ❑ 3. fir6perlyGraded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> /1'-CWnkng Frequency <br /> Structure Operation t WaIV <br /> ❑ IV Q 1wooth/Cleanable <br /> ❑ ❑ ClJaning Frequency <br /> Structure Operation tqaos <br /> ❑ V ❑ WICbridition <br /> 11. San' tion <br /> Structure Operatio Foo <br /> ❑ ❑ 12. Storage <br /> 0 El 13. InsectlVermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ vall from Premises <br /> ❑ 15. Ot <br /> Structure I operati ge Disposal <br /> ❑ ❑ 1 tic System I <br /> ❑ ❑ 17. S41er A <br /> Structur O tion Rab' s Vaccination RECEIVED B INSPECTO <br /> ❑ ❑ Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page \ of <br />