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EHD 40-06 6/30/2005 Page - of <br />SAN JOAQUIN COUNTY <br />DBIf4q <br />I ��+ <br />ENVIRONMENTAL HEALTH DEPARTMO�4T <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Structure Operation Water Well <br />Telephone. (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />4LA "rS0"z K\ A4'A <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 Page - of <br />POULTRY RANCH <br />DBIf4q <br />I ��+ <br />INSPECTION DATE <br />Structure Operation Water Well <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />4LA "rS0"z K\ A4'A <br />00► <br />REINSPVTIOND E <br />U40 <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPERATOR <br />1 <br />P9014E <br />❑ ❑ 3. Spreading and Disking <br />C1 <br />4. Concrete Tanks <br />I ECTION TYPE r __ / <br />T- 1 /�: LL�zwj <br />PRO <br />1 <br />ELEMENT <br />52 <br />RECORD ID <br />❑ ❑ 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 />a <br />A 1 <br />El El`�/! <br />7. Bu in with 2" of Cover <br />❑ <br />❑ <br />8. Approved Concrete Tank <br />Ar <br />N <br />Q a <br />Cl ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />SZL VA -6-&-A <br />❑ ❑ 10. Domestic Fl <br />❑ <br />❑ <br />11. Fannia Fl <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />❑ ❑ 16. Moderate Population <br />❑ <br />❑ <br />17. Heavy Population <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />1 18. Water Troughs <br />❑ ❑ 19. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />Structure Operation Houses <br />❑ <br />❑ <br />21. Floors <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency <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 />❑ ❑ 6. Covin <br />❑ <br />❑ <br />7. Cleaning Frequency <br />Structure Operation Walls <br />❑ <br />❑ <br />8. Smooth/Cleanable <br />❑ ❑ 9. Cleaning Frequency <br />Structure <br />Operation <br />Cages <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 />❑ ❑ 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />16. Septic System <br />❑ ❑ 17. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEIV <br />--%\1F� <br />I SCECTOR <br />El ❑ 18. Certificate on Premises <br />EHD 40-06 6/30/2005 Page - of <br />