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SAN JOAQUIN COUNTY <br /> o .r <br /> tNVIRONMENTAL HEALTH DEPARTME T <br /> to�. <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 /> 4(iFOFgCE <br /> VECTOR CONTROL INSPECTION FORM <br /> P O U L T R Y RANCH DBA INSPETIO DATE <br /> Structure Operation Water Well � <br /> El1. Well Construction' PREMISE ADDRESS REINS CTI N DATE <br /> ❑ ❑ 2. Cross-Connection ., -C I ®ht <br /> Structure Operation Manure Management OWNERIOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking CL L <br /> ❑ 4. Concrete Tanks INSPECTIO TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning 3 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be correct d: <br /> Structure Operation Bird Disposal . <br /> ❑ 7. Burying with 2"of Cover i (V'-5 �L <br /> ❑ ❑ 8. Approved Concrete Tankt <br /> ❑ E39. Removal from Premises 7-p l ` � <br /> Structure Operation Vector Control <br /> ❑ 0 10. Domestic Fly - , ✓ <br /> 0 El 11. Fannia FI <br /> ❑ 0 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult t <br /> 15. Light Po ulation <br /> ❑ ❑ 16. Moderate Population of1.0 <br /> ❑ El 17. Heavy Population <br /> Structure operation Feeding/Water ` O <br /> ❑ ❑ 18. Water Troughs <br /> El ❑ 19. Cups or Bowls Q <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ MC-L- <br /> 11 21. Floors �- <br /> c <br /> ❑ ❑ 22. Walls/Ceilings kA> t <br /> ❑ 0 23. Cleanin Fre uenc <br /> KENNEL (� <br /> Structure Operation I Water Well <br /> ❑ ❑ 1. Well Construction a- <br /> 2. Cross Connection \\ <br /> Structure Operation Floors "p' G <br /> ❑ 3. Properly Graded to j <br /> ❑ 0 4. Drain <br /> ❑ El 5. Smooth/Cleanable _ <br /> ❑ El 6. Covin <br /> ❑ ❑ 7. CleaninR Frequency _ - I <br /> Structure Operation Walls �l/✓ ( <br /> ❑ El 8. Smooth/Cleanable <br /> ❑ 0 9. Cleaning Frequency L L O <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food 4 Z <br /> ❑ ❑ 12. Storage <br /> 11 El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises l` t^- e <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 0 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEI I S ECTOR <br /> ❑ D 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 V opPage of <br />