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" c ,.SAN aJOAQUIN COUNTY <br />EN IDEPARTRONMENTAL HEALTH T <br />to -< 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 />�<ti=ORS <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 Page - of <br />POULTRY RANCH <br />DBA <br />INSPECON DAT <br />o o77 <br />Structure operation Water Well <br />❑ <br />❑ <br />1. Well Construction <br />PR ISE ADDRESS <br />R NSP CTION QIATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />operation <br />Manure Management <br />OWNER/OPERATOR <br />CA; \, <br />/PHONE <br />❑ [:]3. Spreading and Disking <br />❑ <br />❑ <br />4. Concrete Tanks <br />INSPECTION TYPE <br />� /�%� <br />PROGRAM ELEMENT <br />I A+45I-- <br />RECORD ID <br />❑ ❑ 5. Lagooning <br />13 <br />❑ <br />6. Composting <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disposal <br />IN <br />❑ ❑ 7. Burying with 2" of Cover <br />❑ <br />❑ <br />8. Approved Concrete Tank <br />❑ ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />❑ ❑ 10. Domestic Fl <br />❑ <br />❑ <br />11. Fannia Fl <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />❑ ❑ 14. Adult <br />Cl <br />❑ <br />15. Light Po ulation <br />❑ ❑ 16. Moderate Population <br />❑ <br />❑ <br />17. Heavy Population <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Troughs <br />❑ ❑ 19. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />Structure Operation Houses <br />❑1 <br />❑ <br />1 21. Floors <br />❑ ❑ 1 22. Walls/Ceilings <br />❑ <br />❑ <br />1 23. Cleaning Frequency <br />KENNEL <br />Structure <br />Operation <br />I 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 S stem <br />❑ ❑ 17. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEIVED BY 4 <br />l •Q �' <br />INSPECT <br />1�1�.`�iWIR <br />11 C318. Certificate on Premises <br />EHD 40-06 6/30/2005 Page - of <br />