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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd floor, Stockton, CA 95202-2708 R <br /> Telephone: (209)468-3420 Fax. (209)464-0138 Web: www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DB� INSPECTION DATE <br /> Structure Operation Water Well (E- �iQ4Z` <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS � REINS TION D E <br /> El El 2. Cross-Connection - i�1��p14I� Roo-CAU <br /> Structure Operation Manure Management 0WNERIOPERATOR - PIRAE <br /> ❑ ❑ 3. Spreading and Disking 5 <br /> I <br /> 1�7 ❑ 4. Concrete Tanks INSPECTION TYPE PROC-,RA ELEMENT RECORD ID <br /> ❑ ❑ S. Lagooning `� <br /> ❑ ❑ 6. Composting 1 he items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> i <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises Q� �/� 41> 6 <br /> Structure operation Vector Control <br /> ❑ ❑ 10. Domestic Fly ^JVA47,�l <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure I Operation FeedinWWater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses - - <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ 1 ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> © ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. SmoothlCleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Fr uenc <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> _ Structure Operation Food <br /> ❑ ❑ 12. Stora e <br /> - I <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Semetnre Operation Rabies Vaccination RECEIV I ECTOR i <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/3012405 <br /> Page_of <br /> r <br /> f <br />