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SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> • 600 East Main Street Stockton, CA 95202-3029 <br /> �P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> phi <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA ''`` //^n r INSrYT �NyD TE <br /> Structure Operation V� ` wt�n G✓� 1 1�l <br /> ❑ ❑ i. Well Construction PREMISE ADDRESS C l`� RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection ;22f4-I S,✓ r �J � c <br /> Structure Operation Manure Management OWNER/ PERATOR /i PHONE <br /> ❑ ❑ 3. Spreading and Disking o L' l (;v- ,V- 3&5- <br /> 4.❑❑ ❑❑ I <br /> Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT WRD I0 <br /> 5. Lagooring LjL{ j <br /> j- " <br /> El 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> ❑ ❑ 8. An6roved Concrete Tank ,q <br /> El 1:1 9. I moval from Premises (,�1.'I ell 6,006k 1 <br /> Structure Operation Ve for Control <br /> ❑ iti,on <br /> 1 . Domestic FI <br /> ❑ 1. Fannia FI f1 I <br /> ❑ 12. Larvae K'e- r� GLI-e C I-Z a d1 �Y 00d 'S <br /> ❑ 13. Pu ae <br /> ❑ 14. Adult <br /> ❑ 15. Li ht Po ulation y/ C16. Moderate Po ulation v �i ood 'S f o�r I , I rrC� rI h <br /> ❑ 17. Heav Po ulationstructure Feeding/Water18. WaterTrou hs <br /> ❑ 19. Cu s or Bowls <br /> ❑ 20. Food Stora eStructure Houses❑ 21. Floors❑ 22. Walls/Ceilings Ir , �V X141 �'���01od-t-d D <br /> ❑ 1 ❑ 23. Cleaning Frequency <br /> Structure Operation Water Well <br /> 1:12 <br /> / ,�^ <br /> 1 struction c �6'lN S -`�-� c, J e- I(f- -S <br /> ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Pro eriGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable It <br /> ❑ ❑ 6. Coving O --d <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ VD 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 4 Q 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 1 Sto <br /> 13. Insec rtnin <br /> Structure Operation Animal Disposal <br /> ❑ 14 Removal from Premises <br /> ❑ ❑ 15. Other / <br /> Structure Operation Sewage Disposal <br /> ❑ (7 16. tem <br /> ❑ JI ❑ 17. Sewer <br /> 2)::�A' . <br /> Structure Operation Rabies Vaccin RE Iv /�' INSPECTOR p <br /> 11 41. ❑ 18. Cert' t ices ( � " <br /> VECTOR CeNTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />