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0 SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL 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 />EHD 40-06 6/30/2005 <br />POULTRY RANCH <br />DBA <br />��� <br />INSSPPECTI DAT <br />_ ,O 8 �5 <br />Structure Operation Water Well <br />❑ <br />❑ <br />I. Well Construction <br />PREMISE ADDRESS <br />l <br />'� <br />REINJ(PECTIC64 DATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Management <br />OWNERI <br />PHONE <br />(l <br />❑ ❑ 3. Spreading and Disking <br />❑ <br />❑ <br />4. Concrete Tanks r <br />INSPECTION <br />PROGRAM ELEMENT <br />A' <br />RECORD IID <br />I AR D ( vb'a-5 <br />El❑ 5. Lagooning <br />❑ <br />❑ <br />6. Composting <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disposal <br />44.j1 -- <br />❑ ❑ 7. Burying with 2" of Cover <br />❑ <br />❑ <br />8. Approved Concrete Tank <br />❑ ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />❑ ❑ 10. Domestic FI <br />❑ <br />❑ <br />11. Fannia FI <br />WV <br />C <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />cmN-4g- <br />1✓V <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />\Z/O <br />4 voo <br />❑ ❑ 16. Moderate Population <br />❑ <br />❑ <br />17. Heavy Population <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Troughs <br />/ es <br />❑ ❑ 19. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />Led <br />Structure Operation I Houses /-WT.AA4 <br />❑ <br />❑ <br />21. Floors <br />/y <br />❑ I ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency� <br />- <br />�- <br />4iA 7V -- <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />❑ ❑ 1. Well Construction <br />❑ <br />❑ <br />2. Cross Connection <br />Structure Operation Floors <br />❑ <br />❑ <br />3. Properly Graded to <br />❑ ❑ 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />'S V� <br />❑ ❑ 6. Covin <br />❑ <br />❑ <br />7. Cleaning Frequency <br />Structure Operation Walls <br />❑ ❑ 8. Smooth/Cleanable <br />❑ ❑ 9. Cleaning Frequency <br />Structure <br />Operation <br />Cages <br />.r <br />❑ ❑ 10. Condition <br />❑ <br />❑ <br />11. Sanitation <br />Structure Operation Food <br />❑ <br />❑ <br />12. Storage <br />❑ ❑ 13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />©r <br />❑ ❑ 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />16. Se tic S stem <br />❑ ❑ 17. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEIVED IPY <br />lea <br />INSPE <br />❑ ❑ 18. Certificate on Premises <br />EHD 40-06 6/30/2005 <br />