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r� <br /> ®1"a U'" s SAN JOAQUIN COUNTY <br /> � y a E; vIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA I9 ,.. INSPETIONDAE _ <br /> structure Operation Water Well ; L- -t-A- <br /> ❑ ❑ 1. Well Construction ` PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection oX 15 . v <br /> Structure Operation Manure Management OWNER/OPERATORPHONE <br /> , _ <br /> 113. Spreading and Disking \S - " t ® S <br /> ❑ 4. Concrete Tanks ` INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El 5. Lagooning tom, <br /> ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure operation Bird Disposal .® <br /> ❑ ❑ 7. Burying with 2"of Cove - <br /> ❑ El 8. Approved Concrete Tank n <br /> ❑ ❑ 9. Removal from Premises ® O (�- <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI o" - vx'u l <br /> ❑ ❑ 11. Fannia FI ` <br /> ❑ El 12. Larvae 6\ <br /> ❑ ❑ 13. Pupae <br /> ❑ D 14. Adult <br /> ❑ 15. Li ht Po ulation <br /> ❑ 16. Moderate Po ulation j <br /> ❑ 0 17. Heavy Population ` i <br /> Structure operation Feeding/Water - �t `- <br /> 18. Water Troughs ii <br /> ❑ 0 19. Cups or Bowls $ V 1 e <br /> ❑ El 20. Food StoraLe - <br /> It <br /> Structure Operation Houses <br /> - C Ls�s .w--< q=='M- <br /> 0 D 21. Floors � { <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Frequenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection , <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ El 4. Drain I <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls ` "'�✓ <br /> 8. Smooth/Cleanable ..r <br /> 11 11 9. CleaningFrequency 'eLl` <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition �l9 <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food ✓'{� <br /> ❑ ❑ 12. Storage <br /> ❑ 0 13. Insect/Vermin ®\\ ® S L <br /> Structure Operation Animal Disposal �- <br /> ❑ ❑ 14. Removal from Premises O <br /> ❑ 0 15. Other <br /> Structure Operation Sewage Disposal <br /> QN- <br /> El 0 16. S tic System <br /> 11 0 17. Sewer <br /> Structure Operation Rabies Vaccination REC D BY IN TOR <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />