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1 <br /> oA4Uty c SAN JOAQUIN COUNTY <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> rte:•- :.•:;� Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA/ r INSPN D E <br /> Structure OperationWater Well X- <br /> ❑ ❑ 1. Well Constructs PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Conn on SV le� <br /> Structure operation Manure Man gement OWNER/OPERATOR PONE <br /> ❑ ❑ 3. Spreadin 96nd Disking C4- <br /> ❑ ❑ 4. ConcreVTanks INSPECTION TYPE PROGRAM ELE®MEENT RE ORD ID <br /> ❑ 5. Lag ing J 7 <br /> ❑ ❑ 6. Co sting The items below represent code violations and must be corrected: <br /> Structure Operation Bir isposal <br /> ❑ ❑ 7.Aurying with 2-of Cover <br /> ❑ ❑ . Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises s <br /> Structure operation Vector control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ El 12. Larvae <br /> ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population 44 A <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls ' <br /> 20. Food Storage <br /> Stru ture Operation Houses <br /> ❑ 21. Floors 9 <br /> ❑ ❑ 1 22. Walls/Ceilings IeA ✓tee 0 <br /> 1-1 <br /> ❑ ❑ 23. Cleaning Fr uenc <br /> Structure Operation <br /> ❑ ❑ ell Construction 14 <br /> 2. Cro§§Connection <br /> Structure Operation< <br /> ❑ ❑ 3. Prod Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin V® <br /> 7 nin Frequency <br /> Structure Operation <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. CleaningFrequency <br /> Structure Operation ag@ <br /> ❑ ❑ =Removal <br /> 11 <br /> Structure Operation 'Food <br /> ❑ ❑ <br /> Structure OperationS❑ ❑ m Premises <br /> ❑ 1❑ 15. <br /> Structure Operation ewage Dis <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 17. <br /> Structure operation abies Vaccination REC B IN P CT R <br /> ❑ ❑ 18. n remise J <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of� <br />