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SAN JOAQUIN COUNTY <br />Ell R0NMENTAL HEALTH DEPARTMIW�47 <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 />CZ <br />VECTOR CONTROL INSPECTION FORM <br />Structure <br />POULTRY RANCH <br />DBA <br />INSPECT N DAT -7 <br />Structure <br />Operation <br />Water Well <br />7. Burying with 2"ofCover <br />El <br />El <br />1. Well Construction <br />PREMISEADDRESS <br />REIN PEYCTIO y"ATE <br />1:1 <br />El <br />2. Cross -Connection <br />El <br />9. Removal from Premises <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPE TOR <br />Vector Control <br />Pi <br />11 <br />❑ <br />3. Spreading and Disking <br />CN_4t10_Ar <br />10. Domestic Fly <br />;r2 <br />0 <br />E] <br />4. Concrete Tanks <br />INSPECTION TYPE <br />PROGRAM ELEMENT <br />RECORD ID <br />1 11 <br />1 0 <br />1 5. Lagooning <br />C6M;P"A\ <br />1 445z' <br />I <br />I M <br />I M <br />1 6 Corrinnting <br />The it,-Nq helow renre-ent code violations and must be corrected: <br />13. Pupae <br />Structure <br />Operation <br />Bird Disposal <br />0 <br />n <br />7. Burying with 2"ofCover <br />11 <br />El <br />8. Approved Concrete Tank <br />n <br />El <br />9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />__tT_ <br />Alm <br />El <br />El <br />10. Domestic Fly <br />;r2 <br />cmn��C�bLA <br />AA4-- . <br />El <br />1:1 <br />11. Fannia Fly <br />❑ <br />D <br />12. Larvae <br />❑El <br />13. Pupae <br />❑ <br />D <br />14. Adult <br />❑ <br />D <br />15. Light Population <br />El <br />El <br />16. Moderate Po <br />El <br />D <br />17. Heavy Population <br />Structure <br />Operation <br />Feeding/Water <br />El <br />El <br />18. Water Troughs <br />El <br />El <br />19. Cups or Bowls <br />El <br />El <br />20. Food Storage <br />Structure <br />Operation <br />Houses <br />El <br />El <br />21. Floors <br />El <br />El <br />22. Walls/Ceilings <br />D <br />El <br />23. Cleaning Frequency <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />El <br />El <br />1. Well Construction <br />El <br />D <br />2. Cross Connection <br />Structure <br />Operation <br />Floors <br />3. Properly Graded to <br />❑El <br />4. Drain <br />11 <br />El <br />5. Smooth/Cleanable <br />1:1 <br />D <br />6. Coving <br />n <br />D <br />7. Cleaning Fre uency <br />Structure <br />Operation <br />Walls <br />El <br />El <br />8. Smooth/Cleanable <br />0 <br />El <br />9. Cleaning Fmquency <br />Structure <br />Operation <br />I Cages <br />El <br />El <br />10. Condition <br />0 <br />11 <br />11. Sanitation <br />Structure <br />Operation <br />Food <br />11 <br />0 <br />12. Storage <br />El <br />D <br />13. InsecVVermin <br />Structure <br />Operation <br />Animal Disposal <br />11 <br />El <br />14. Removal from Premises <br />11 <br />El <br />15. Other <br />Structure <br />Operation <br />Sewage Disposal <br />El <br />El <br />16. Septic Syst.em <br />El <br />0 <br />17. Sewer <br />Structure <br />1 <br />Operation <br />Rabies Vaccination <br />RECE E BY <br />IN TOR <br />11 <br />El <br />18. Certificate on Premises <br />4 <br />- <br />EHD 40-06 <br />6/30/2005 <br />Page of <br />