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guy... SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> c� ..- ....•;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �/FoR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation12t // <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Diskingr%A i/ T--',,,7(j00 <br /> ❑ ❑ 4. Concrete Tanks IN CTION T9PE. PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning PCOCA <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover 2112 C <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises jJ14 f 110k1d ®' <br /> Structure operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> 1:1El13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls t <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> structure4eratfon Water Well <br /> ❑ 111. Well Construction <br /> ji 2. Cross Connection <br /> Structure Operation Floors f <br /> ❑ ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain C <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ to`L-❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Stricture Operation Food <br /> ❑ ❑ 12. Storage <br /> El 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> e <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal 4yz 42 ® v,_ krcz2rY ,(/ <br /> ❑ ® ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure enation Rabies Vaccination RE D 9Y JZ NSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page rf of_ <br />