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r <br /> o¢a�!lfy, c SAN JOAQUIN COUNTY <br /> _ 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 /> �rFOit <br /> VECTOR CONTROL INSPECTION FORM <br /> DBAF, INS CTIA ®TE <br /> Structure Operation <br /> ❑ ❑ 1. Well construction PREMISE ADDRESS RE-INSPECTION DATE <br /> Water Well <br /> ❑ ❑ 2. Cross-Connection 3 C' <br /> Structure Operation Manure Manage, nt OWN E OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and sking 119 145 <br /> ❑ ❑ 4. Concrete Ta s INSRECTION TYPEPROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning y y S 1104 �-3 <br /> ❑ ❑ 6. Compostipig The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp6sal <br /> ❑ ❑ 7. Bu i with 2"of Cover l <br /> ❑ ❑ 8. A oved Concrete Tank <br /> ❑ ❑ 9. R oval from Premises <br /> Structure Operation veptor Control <br /> ❑ ❑ 1 Domestic FI <br /> 1. Fannia FI _ <br /> ❑ ❑ 12. Larvae g <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structureperation Feeding/Water <br /> 11 ❑ 18. Water Troughs Ate <br /> ❑ A ❑ 19. Cups or Bowls <br /> L20. Food Storage <br /> S Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation ater We-y - <br /> ❑ ❑ nstruction .� <br /> 2. Cross Connection <br /> Structure Operation 17I00 <br /> ❑ ❑ .-Properly Graded to Sewer <br /> ❑ ❑ . Drain s . <br /> ❑ ❑ . Smooth/Cleanable <br /> 13 0 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls r <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9._9@Lning Frequency <br /> Structure Operation Cage <br /> ❑ ❑ Condition <br /> 1 itation <br /> Structure Operati d <br /> ❑ ❑ Stora e <br /> 13. i <br /> Structure Operation 4knimal Dis OS <br /> ❑ ❑ moval from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 1 e tic System <br /> ❑ 17. Sew <br /> structure opera ables Vaccinati R IVSD Y INSPECTOR <br /> ❑ tate on Premises d' <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page J-of <br />