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t <br /> ®Pa u i N c SAN JOAQUIN COUNTY <br /> Q? EN IRONMENTAL HEALTH DEPART _ T <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 /> a VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA a INSPE TION D TE <br /> Structure IL operation I Water Well <br /> ❑ MAI❑ 1 1. Well Constructio PREMISE JWDRESS d REI SPECTI N DATE <br /> 1:1El2. Cross-Connection /f <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking sks 7 <br /> ❑ ❑ Tanks I PECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 11 ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure 1 Operation Bird Disposal <br /> ❑ El 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ from Premises <br /> Structure Operation Vector Control A J <br /> ❑ ❑ 10. Domestic Fl u <br /> ❑ ❑ i l. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population )qf � <br /> E] El16. Moderate Po ulation <br /> ❑ ❑ 17. Heavy Population gga <br /> Structure Operation Feeding/Water 6 t i <br /> ❑ ❑ 18. Water Troughs close <br /> 1119.. or Bowls ar �/ <br /> ❑ ❑ 20. Food Storage 1t t <br /> StructureVeolr <br /> noon H®Uses vel 91 <br /> ❑ 21. Floors a <br /> El22. Walls/Ceilings <br /> s / <br /> ❑ 023. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction "ofac+ Ek D whM 01 a&We- io:Lf's <br /> ❑ ❑ 2. Cross Connection <br /> StructureOperation Floors <br /> 00 <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ NO 1 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 18. Smooth/Cleanable <br /> ❑ 0 . Cleaning Frequency <br /> Structure Operation ges <br /> ❑ ❑ 1 Condition <br /> ❑ El 11. Sanitation <br /> Structure Operation FOO <br /> ❑ ❑ 12. Ora e <br /> ❑ 13. In ect/Vermin <br /> Structure operation Anima Disposal <br /> ❑ ❑ 14. Re vat from Premises <br /> ❑ ❑ 018. CertiNficateo <br /> Structure Operation sal <br /> 11 ❑ tem t <br /> ❑ <br /> Structure Operation n tion RECEIVED BY IN EC <br /> ❑ ❑ e o Premises <br /> EHD 40-06 6/30/2005 Page of <br />