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�®PQ u i" SAN JOAQUIN COUNTY co EN ONENTAL HEALTH DEPART.*T 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 ` Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd '�(IFpRC1 VECTOR CONTROL INSPECTION FORM POULTRY RANCH DBA , INSPECIOND E Structure Operation Water Well ❑ ❑ 1. Well Construction PREMISE ADDRESS 4 REiN&eEC'i6ON DATE ❑ ❑ 2. Cross-Connection OL Structure Operation Manure Management OWNER/OPERATOR PAONE- ❑ ❑ 3. Spreading and Disking ❑ ❑ 4. Concrete Tanks I ECTION TYPE PROGRAM ELEMENT RECORD ID 4 El 5. Lagooning o ❑ ❑ 6. Composting The items bel w represent code violations and must be corrected: Structure Operation Bird Disposal ❑ ❑ 7. Burying with 2"of Cover ❑ ❑ 8. Approved Concrete Tank ❑ ❑ 9. Removal from Premises Sa AAw-lo-ifA Structure Operation Vector Control ❑ ❑ 10. Domestic FI ❑ ❑ 11. Fannia Fl ❑ ❑ 12. Larvae ❑ 1 ❑ 13. Pupae ❑ ❑ 14. Adult ❑ 15. Light Population ❑ ❑ 16. Moderate Population ❑ ❑ 17. Heavy Population Structure Operation Feeding/Water ❑ 0 18. Water Troughs ❑ ❑ 19. Cups or Bowls ❑ El 20. Food Stora e Structure Operation Houses ❑ ❑ 21. Floors ❑ ❑ 22. Walls/Ceilings ❑ ❑ 1 23. Cleaning Frequency KENNEL Structure Operation Water Well ❑ ❑ 1. Well Construction ❑ ❑ 2. Cross Connection Structure Operation Floors ❑ ❑ 3. Properly Graded to ❑ ❑ 4. Drain ❑ ❑ 5. Smooth/Cleanable ❑ ❑ 6. Covin ❑ ❑ 7. Cleaning Frequency Structure Operation Walls ❑ ❑ 8. Smooth/Cleanable ❑ 0 9. CleaningFre uenc Structure Operation Cages 11 El 10. Condition ❑ ❑ 11. Sanitation Structure Operation Food ❑ ❑ 12. Storage ❑ ❑ 13. Insect/Vermin Structure Operation Animal Disposal ❑ El 14. Removal from Premises ❑ ❑ 15. Other Structure Operation Sewage Disposal 11 ❑ 16. Septic System ❑ ❑ 17. Sewer Operation Rabies Vaccination L ❑ 18. Certificate on Premises EHD 40-06 6/30/2005 Page Of_