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i <br /> SAN JOAQUIN COUNTY <br /> y 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 /> /PORN <br /> PT40039,28 VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC ON AT <br /> Structure Operation Water Well bt6tiewa'a J&kkea <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS �i RE-INSPEC ION DATE <br /> 1:10 2. Cross-Connection N. e <br /> Structure Operation Manure Mana eme t OWNER/ PERATO HO E ? <br /> ❑ [33. Spreading and Di ing hwil hp)&A7 <br /> ❑ ❑ 4. Concrete Tank INSP IONPSE PROGRAM ELEMENT RECORD ID <br /> ❑ [:] 5. Lagooning O- <br /> ❑ ❑ 6. CompostinAf The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis sal <br /> ❑ ❑ 7. Bu i with 2"of over <br /> ❑ ❑ 8. Appil Concrete Tankm <br /> 1:1 El 9. 0-oval from Premises <br /> Structure Operation V for Control N <br /> ) c <br /> 11 110. Domestic FI / 0 <br /> 11 0 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult 1 e ! f� <br /> ❑ 15. Li ht Population �®® <br /> ❑ 16. Moderate Population L <br /> ❑ 17. Heavy Po ulation / <br /> Structure peration FeedingANater I S <br /> 11 ❑ 18. WnterTrou hs r s <br /> ElEl19. Cups or Bowls t yL re. <br /> 20. Food Stora e $ Z <br /> Strut Operation Houses � t v (,t � <br /> 11 1:1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings It <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> Structure Operation ell <br /> ❑ r0pemtlon <br /> 1. nstruction <br /> El 2. Cross Connection t <br /> Structure Floors fttltired❑ 3. ProperlyGraded to Sewer ° <br /> El4. Qp9li ane <br /> ❑ ❑ 5. o nable <br /> El 6. l <br /> 7. fAiiding Frequency <br /> Structure Operation <br /> ❑ ❑ 8. leanable <br /> Cl C 1, ❑ 91-CI re uenc <br /> Structure Operation ages <br /> ❑ IFFT�- . <br /> El 1 . itation <br /> Structure Operation F <br /> ❑ J0 ❑ <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ Re m Premises <br /> ❑ ❑ 15. Other <br /> Structure pperation Sewaa Disposal <br /> ❑ 16. Se tem <br /> ❑ ❑ 1'77-Sewer ft <br /> Structure pera6on Rabies Vaccination Ill Y INSPECTO <br /> ❑ UO ❑ 8. on Premises jr1r", 410 1A <br /> VECTOR CONTROL INSPECTION FORM <br /> El 40-06 12/04/08 7 <br /> Page_of <br />