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SAN aTOAQUINCOUNTY <br /> �: oG <br /> a... <br /> E PikONMENTAL HEALTH DEPARTM <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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAO';`r� INSPE ION E <br /> Structure Operation Water Well V <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS R5&SPEchoF4 DATE <br /> ❑ ❑ 2. Cross-Connection q57 <br /> Structure Operation Manure Management OWNERIOPERATOR PHONE /f <br /> ❑ ❑ 3. Spreading and Disking 2- v Z'79 <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning Co IV\ ' k' <br /> ❑ ❑ 6. Composting The items be ow represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank N U <br /> ❑ ❑ 9. Removal from Premises <br /> Sim A-+4vv- <br /> Structure Operation Vector Control <br /> ❑ I ❑ 10. Domestic Fl <br /> Cl ❑ 11. Fannia Fl <br /> ❑ V 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilin s r� <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ I. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 11 C17. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <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 /> Structure Operation Rabies Vaccination RE Y INS O <br /> ❑ El 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />