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1) TRAVEL TIME <br />MIN. C% <br />HRS. <br />2) DATE 1~L�iC1 <br />5 ACCESS ROADS <br />6 .DRAINAGE <br />7 WATER POLLUTION <br />�+ 8 HUMAN SAFETY HAZARDS <br />9 ANIMAL SAFETY HAZARDS <br />10 WALLS <br />11 FLOORS <br />12 WALKWAYS <br />13 RUNWAYS (Kennels) <br />14 BENEATH CAGES <br />15 BUILDINGS <br />16 RESTROOMS <br />17 FENCING <br />VECTOR BIOLOGY CONTROL <br />INSPECTION REPORT 3) PURPOSE <br />SAN JOAQUIN LOCAL HEALTH DISTRICT R FU CON COM 0TH <br />DIVISION OF ENVIRONMENTAL HEALTH O Q <br />MARKED ITEMS REPRESENT VIOLATIONS TO BE <br />CORRECTED AS INDICATED ON ATTACHMENTS 4) Inspection Time <br />18 CONSTRUCTION [] <br />19 POTABLE <br />20 CONDITION [] <br />-� 21 CROSS CJNNECTIONS Q <br />3 22 WATERING METHOD <br />a CUPS <br />BOWLS <br />a TROUGH ` <br />23 OVERFLOW DRAINAGE <br />FROM SPRINKLERS [l <br />24 VETERINARIANS) <br />NAME <br />ADDRESS <br />PE 25 RABIES VACCINATIONS Q <br />CURRENT (KENNELS) <br />= 26 FEEDING REGIMEN POSTED [] <br />(EACH ANIMAL KENNEL) <br />27 PROPER CONFINEMENT CAGES Q <br />FOR DISEASED ANIMALS <br />28 BEDDING Q <br />29 NUMBER RUNS G�fp <br />30 NUMBER ROWS OF CAGES -)f <br />zo 31 CLEANING .FREQUENCY [] <br />DAILY <br />EVERY OTHER DAY <br />z WEEKLY 0 <br />32 CLEANING METHOD {' LIuL_ :_h, <br />33 LANDFILL 0 <br />34 SPREADING AND DISCING [] <br />35 COMPOSTING <br />J 36 LAGOONING [] <br />0 37 CONCRETE TANKS Q <br />38 SEPTIC SYSTEM (KENNELS) [� <br />Q 39 PERMIT 4 <br />40 HISTORY OF FAILURE <br />41 STORAGE METHODt i <br />42 CONCRETE PAD <br />w 43 TIGHT FITTING COVER [] <br />0 44 MANURE PROPERLY COVERED Q <br />C, 45 ALTERNATE METHOD <br />46 RESTROOM FACILITIES <br />w 47 HOT AND COLD WATER <br />z <br />48 INDIVIDUAL TOWELS <br />Y <br />49 HAND SOAP Q <br />50 REFUSE/GARBAGE DISPOSAL <br />0 <br />51 NON ABSORBENT CONTAINERS [] <br />52 TIGHT FITTING LIDS (] <br />-r 53 BURYING WITH 2' OF COVER [� <br />g 54 APPROVED CONCRETE TANK <br />55 REMOVAL FROM PREMISES <br />� STORAGE ON PREMISES <br />LANDFILL DISPOSED AT <br />0 <br />IN <br />DO <br />LIJI LgUIrMtNI VIULHIIUN <br />BUSINESS N ME PSR ORS NiME <br />!u L_ <br />OWNER LAND/OWNER-BIRDS-DOGS <br />i ` I� L _ <br />G % ONT CT PERS N M-E/PHONE NUMBER " <br />CHEMICALS USED <br />,, -l--1)" - I-"' u .- T <br />eIti <br />S �9� PERMIT NUB R <br />PLRM11 LXPIRAilON DA1E�` <br />S ESS ADDRESS DATE <br />TYPE OP kATION NUMBER BIRDS/ OGS <br />NUMBER HOUSES OP L ION ER <br />HOUSE OPER. MONTHLY i YEARLY ®- `SE S N <br />— <br />bU <br />AIN . S RUC . <br />TY ES/BIRDS - DOGS PER CAGE Q <br />72 WATER TROUGHS <br />A S F LL ON/ NDS USED (] LEAKING <br />SQUARE FEET OR, CONCENTRATION 0 CROSS CONNECTION <br />(UNIT SPACE) j: �tt1y_ 73 CUPS OR BOWLS [J <br />61 <br />62 <br />FREQUENCY OF APPLIC TION '1}; dct z C- LEAKING <br />STORAGE OF PESTICIDES/RODENTCIDES W 74 FOOD. TROUGH CONST. L [] <br />C:) TIGHT -FITTING <br />63 <br />64 <br />EMPLOYEE PROTECT—ION <br />EMERGENCY WASHDOWN <br />a 0 SPILLAGE NOTED <br />75 FOOD STORAGE Q [] <br />o 0 STORED ON PALLET <br />OFF FLOOR <br />65 <br />66 <br />ASPIRATORS kt6 <br />RUBBER SUITS, GLOVES, OTHER <br />LL, <br />0 SPILLAGE NOTED <br />76 VERMIN NOTED 0 �J <br />PROTECTION i(?'> <br />67 <br />MUSCA DOMESTICA FLY;LIGHT:MODERATE HEAVY 70 -SAMPLES TAKEN_ x? <br />1. LARVAE 0 <br />2. PUPAE 0 <br />[] Q <br />3, ADULT 0 V <br />(] Q <br />68 <br />FANIA FLY <br />71 ESTIMATED INFESTATION/HARBORAGE <br />1. LARVAE 0 Q <br />[j Q i'fU g.: <br />2. PUPAE [) [] <br />(] (] <br />3. ADULT (-� <br />Q 0 <br />69 <br />OTHER <br />p L� <br />7 <br />GENERAL CONDITION <br />Pq G Q <br />RECLIVLUt-' <br />Ell 12-17 12/79 200 Sets <br />