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P°" " SAN JOAQUIN COUNTY 'O <br /> �o ico <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> hx "" Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSP CTIO DATE <br /> Structure Operation Water Well <br /> ❑ 1. Well Construction PREMISE ADDRESS {� REIN&PECTf0N DATE <br /> ❑ 2. Cross-Connection n \" <br /> Structure Operation Manure Management OWNER/OPERATOR ®_ PHONE i <br /> a C13. Spreading and Disking [ J 'C- <br /> 81 <br /> ❑ 4. Concrete Tanks INSPECTION`TYPE PROGRAM ELEMENT RECORD ID i <br /> 11 ❑ 5. Lagooning �tsE✓`t t rJC'C) <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal _ <br /> ❑ 0 7. Burying with 2"of Cover ® 4 L is �� ®►� <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control ` <br /> ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> ❑ 0 12. Larvae OL\& 4 <br /> ❑ D 13. Pupae <br /> ❑ 14. Adult <br /> ❑ 15. Li ht Population <br /> ❑ El 16. Moderate Population \-",v " <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water '� <br /> ❑ 0 18. Water Troughs <br /> ❑ El 19. Cups or Bowls , l \ ®\ <br /> El 0 20. Food Stora <br /> Structure Operation Houses -^t,q,� `� `z v,t,& <br /> = 1. <br /> ❑ 21. Floors t <br /> ❑ 22. Walls/Ceilings L'�-v\ 1 0 <br /> El ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction 0 L" �d .t <br /> ❑ ❑ 2. Cross Connection � �B - <br /> Structure Operation Floors Ca\ \'L p IAvA <br /> ❑ ® 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> El D 5. Smooth/Cleanable t \ <br /> ❑ El 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleanin Fre ue cy iv-S C <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition \ \ <br /> ❑ ❑ 11. Sanitation r - <br /> Structure Operation Food l <br /> 11 0 12. Storage <br /> ❑ ❑ 13. Insect/Vermin pv� kvk <br /> Structure Operation Animal Disposal _ <br /> 11 ❑ 14. Removal from Premises 4, ®4 ®Ckl�c <br /> ❑ ❑ 15. Other 1 [ t <br /> Structure Operation Sewage Disposal ` L t ® l\� <br /> 16. Septic System <br /> El El 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED I PECTO <br /> ❑ 18. Certificate on Premises _ <br /> EHD 40-06 6/30/2005 Page of <br />