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ora"I" . SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • (�q;• .-•NSP Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> /i=OR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA y� INSPECTION DATE <br /> Structure Operation f <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection J"LrS• <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking - <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <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 <br /> R- - :e- a n <br /> ❑ ❑ 8. Approved Concrete Tank ^ <br /> El El 9. Removal from Premises -AAL -c <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Po ulation t <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedinglWater <br /> ❑ ❑ 18. Water Troughs 1 <br /> ❑ ❑ 19. Cups or Bowls All <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses S <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Manyre - <br /> Structure Operation Water Well <br /> El El1. Well Constru n <br /> ❑ 2. Cross Conn ion <br /> S cture Operation Floors <br /> ❑ 3. ProperlyAraded to Sewer <br /> El4. &C a LJJ <br /> ❑ El5. S th/Cleanable <br /> ElEl6. ovin j <br /> ❑ El Ycleaning Frequency <br /> Structure O ration 0,Walls l <br /> El8. Smooth/Cleanable / <br /> El ❑ 9. Cleaning Fre uenc <br /> Structure Ope ion Cages <br /> El 'No Condition <br /> El 1 Sanitation <br /> Structure f Operation FO <br /> 13 El12. 5 ae <br /> 13. Inse ermin <br /> Stru ure Operation Animal oral <br /> El14. Removal Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Dispos <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPE <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />