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SAN JOAQUIN COUNTY <br /> )�s� �•COG <br /> -? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> 9�FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA1 INSPE ION DA E <br /> Structure Operation Water Well L Ch 011 h r �0.r�t 0� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESSP TT ,, ee R NSPECTI N DATE <br /> C <br /> ❑ ❑ 2. Cross-Connection r 1 7 151D C. D.ARS <br /> Structure Operation Manure Management OWNER/OPERATORPHONEc�/ /� <br /> 1:1 ❑ 3. Spreading and Disking L ev, �2W. 6 w5'� <br /> ❑ ❑ 4. Concrete Tanks INSPECTI 1TYPE PROGRAM ELEMENT p,R�ECORD ID <br /> ❑ ❑ 5. Lagooning O tr t l b�f y r7 L 1 `t O'+ 000 33 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal pC r <br /> ❑ ❑ 7. Burying with 2"ofCover �Ml V�S�e- evt s <br /> ❑ ❑ 8. Approved Concrete Tank (' <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI 1 0 Oa b <br /> ❑ ❑ <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult �C$ 6 <br /> ❑ ❑ 15. Light Population -- <br /> ❑ ❑ 16. Moderate Population �- <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> 11 ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well 1I _ <br /> ❑ ❑ 1. Well Construction V� lti <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable �p <br /> ❑ ❑ 1 9. Cleaning FrequencyIJP 3 <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure 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 Operation LRabies Vaccination REC V INSPECT <br /> ❑ ❑ 1 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of <br /> ��3"Zafa <br />