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SAN JOAQUIN COUNTY <br /> � r ENVIRONMENTAL HEALTH DEPARTMENT <br /> y 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA ISE ION DAT <br /> Structure Operation Water Well O 't d�Z7` <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS R NSPECTI DATE <br /> ❑ ❑ 2. Cross-Connection 7 vi W ew VV%Ct VN- <br /> Structure <br /> `Structure Operation Manure Management OWNER/OPERATOR PHONE G/ <br /> 1:1 El 3. Spreading and Disking b -0 I6 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TVEPROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning Z ,0 0CQ <br /> ❑ ❑ 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 /> ❑ ❑ 9. Removal from Premises ( O <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl r+ 000 eAnt <br /> ❑ ❑ 11. Fannia Fly T <br /> 13 El -7 12. Larvae / '? Q o C) \e) 1 <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population 01' <br /> ❑ ❑ 16. Moderate Population r <br /> ❑ ❑ 17. Heavy Population \_ <br /> Structure Operation Feeding/Water e- G Qd J\ D�j <br /> ❑ ❑ 18. Water Troughs ( 1 <br /> ❑ ❑ 19. Cups or Bowls oW S'o o w% SSI lL t� <br /> ❑ ❑ 20. Food Storage ert a/�.� {`5• <br /> Structure Operation Houses /� e <br /> ❑ ❑ 21. Floors / <br /> El C3 22.22. Walls/Ceilings " 7 ✓Ls t <br /> ❑ ❑ 23. Cleaning Frequencyl <br /> KENNEL Wim/ HfG� <br /> Structure Operation Water Well C� J <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection / _ <br /> Structure Operation Floors [� <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain 7 S oa a <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Coin 12- 7 5 d 0 a b <br /> El El7. Cleaning Frequency _ <br /> Structure Operation Walls L/ -3 7 r-, 19 ad \X <br /> ❑ ❑ 8. Smooth/Cleanable L <br /> ❑ ❑ 9. Cleaning Frequency / Hb TSS e1L <br /> Structure Operation Cages e / <br /> ❑ ❑ 10. Condition G � <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage _ <br /> ❑ ❑ 13. InsecWermin rm> • 'o <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 /> Structure Operation Rabies Vaccination REC E Y INS 2 �p <br /> El El 18. Certificate on Premises f rJ2 7!�O <br /> EHD 40-06 6/30/2005 Page_of <br />