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!k SAN JOAQUIN COUNTY <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> r ' = Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSP CTION DATE <br /> v <br /> Structure Operation Water Well k <br /> ❑ ❑ 1. Well Construction PREMM ADDRESS REINsPEcTior4 DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ 1 ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning It <br /> l c? 0 <br /> ❑ ❑ 6. Composting The items bel w re resent code violations and must be correct <br /> Structure Operation Bird Disposal <br /> \>zA11- <br /> ❑ ❑ 7. Burying with 2"of Cover 4❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation vector Control <br /> ❑ ❑ 10. Domestic FI f <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae ow z U±5r, e <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adultrx <br /> ❑ ❑ 15. Li ht Po ulation <br /> ❑ El 16. Moderate Population <br /> ❑ 0 17. Heavy Population t-^7 <br /> Structure Operation Feeding/Water •®+ O <br /> ❑ ❑ 18. Water Troughs <br /> ❑ 0 19. Cups or Bowls <br /> ❑ El 1 20. Food Storage 7 <br /> Structure Operation Houses ® 4 <br /> ❑ ❑ 21. Floors �^ <br /> ❑ ❑ 22. Walls/Ceilings \ 4 <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL "" L <br /> StructureOperation Water Well <br /> 11 ❑ 1. Well Construction <br /> ❑ El 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain • 03 <br /> ❑ El 5. Smooth/Cleanable <br /> ❑ 0 1 6. Coving <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls AA Wi <br /> ❑ 8. Smooth/Cleanable d-w <br /> ❑ 11 9. Cleaning Frequency Ot-!N h. i <br /> Structure Operation Cages <br /> El ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food W <br /> 11 ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> El ❑ 14. Removal from Premises <br /> ❑ 0 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ El 16. Septic System <br /> 11 El 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIV D Y I IN TTOR <br /> c <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of_ <br />