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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> F. <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA r INSPECTION DATE <br /> Structure Operation Water Well f� !r�'t <br /> !- <br /> 110 1. Well Construction PREMISE ADDRESS REINSPE TION DATE <br /> ❑ ❑ 2. Cross-Connection 1 k- I <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking r t� <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning l✓• N <br /> ❑ El 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> 1:1 El �� <br /> 9. Removal from Premises f�' �- <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI e �d <br /> ❑ ❑ 11. Fannia FI <br /> ❑ 0 12. Larvae <br /> 11 El 13. Pupae <br /> ❑ D 14. Adult 111.1 LA e, Zv- <br /> 0 El <br /> 15. Light Population <br /> ❑ El 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> 11 0 18. Water Troughs <br /> ❑ 0 19. Cups or Bowls <br /> 1:1 El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ 1 0 1 21. Floors <br /> P <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL Lei <br /> Structure Operation Water Well <br /> ❑ 0 1. Well Construction l', / <br /> ❑ ❑ 2. Cross Connection <br /> Stm a Operation Floors <br /> ❑ ❑ 3. Properly Graded to ` p <br /> ❑ ❑ 4. Drain [ tll 1 <br /> ❑ ❑ 5. SmoothICleanaJde <br /> ❑ ❑ 6. Covin <br /> 0 NO 7. Cleanin re uenc <br /> r <br /> Structure Ope tion Walls <br /> ❑ 8. S oth/Cleanable <br /> ❑ ❑ 9.Yleaning Frequencya. {� <br /> Structure Operation ages <br /> El ❑ 10. Condition <br /> ❑ 1. Sanitation <br /> c° <br /> Structure Opera on Nod / <br /> ❑ 12 <br /> Storage <br /> ❑ ❑ 13. nsect[Vermin <br /> Structure Operation Ani l disposal <br /> 11 El 14. R oval from Premises <br /> ❑ 15. Oth r <br /> seruc re Operation Sewage hisposal <br /> ❑ 16. Septi stem <br /> ❑ El 17. Sewer <br /> Structure Operation Rabies Vac •nation RECE IN EC R <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />