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all" s SAN JOAQUIN COUNTY <br /> `Z< 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 /> �lFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECON DATE <br /> M00 <br /> Operation <br /> 1. Well Construct n PREMISE ADDRESS REINSPECTION DATE <br /> ❑ 2. Cross-Conn 'on <br /> Structure Operation Manure marAgement OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreadin and Disking <br /> ❑ ❑ 4. Concre Tanks INSAECTIO PE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lag ing q F21td <br /> ❑ 6. co sting The items be ow represent code violations and must be corrected: <br /> Structure opera on Bird isposal <br /> ❑ ❑ 7. u in with 2"of Cover <br /> ❑ ❑ 8/Approved Concrete Tank <br /> ❑ ❑ W. Removal from Premises <br /> Structure operation Nvector Control <br /> ❑ ❑ 0. Domestic FI <br /> 1\. Fannia FI <br /> ❑ 12. Larvae 1 444 <br /> a <br /> ❑ 0 13.1pupae af <br /> ❑ 14. Adult <br /> ❑ ❑ 15. Li t Po ulation <br /> El [:1 16. M rate Population r <br /> ❑ ❑ 17. Heav Po ulation <br /> Structur Operation Feeding/Water <br /> ❑ 18. Water T u hs <br /> ❑ 19. Cups or B s 20. Food Stora <br /> S re Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uen <br /> Structure Operation Water Well <br /> ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ^ ❑ 5. Smooth/Cleanable <br /> El Ll 6. Covin <br /> 7. CleaningFrequency <br /> Structure Operation Walls 1" <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ olL ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food j <br /> ❑ ❑ 12. Storage <br /> El Lj 13. InsecWermin <br /> Structurr operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operktion Rabies Vaccination REeEIVEY SPECT R <br /> 4 <br /> ❑ ❑ 18. Certificate on Premises him <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 / Page Of <br />