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PQ U'" SAN OAQUIN COUNTY <br /> o c <br /> NVI ONMENTAL HEALTH DEPARTME f <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �Fo <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA I ONATEA <br /> Structure Operation Water Well ��. / <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS j/ REINISPEOHON DATE <br /> ❑ ❑ 2. Cross-Connection /16,00 <br /> /! C� <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking / ,, <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <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 j <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> ❑ El 11. Fannia Fl / <br /> ❑ D 12. Larvae <br /> ❑ Cl 13. Pu ae <br /> 0 EI 14. Adult r <br /> ❑ 0 I5. Li ht Po ulation <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 11 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ 0 19. Cups or Bowls �- d <br /> ❑ 0 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> r r <br /> KENNEL <br /> Structure Operation Water Well <br /> f <br /> ❑ 0 1. Well Construction 6zV&1-1f 62 <br /> ❑ 2. Cross Connection <br /> Struct operation Floors <br /> ❑ ❑ 3. Properly Gra to a <br /> f <br /> El ❑ 4. Drain 1 i <br /> ❑ ❑ 5. Smoot leanable <br /> ❑ 6. Covi <br /> ❑ 7. Clgking Frequency <br /> r <br /> Structure Oper -on a s <br /> 11 Smooth/Cleanable <br /> . Cleanin Frequency <br /> Structure operatiouA, Cages <br /> ❑ 10. Condition <br /> ❑ 0 V Sanitation <br /> Structure eration Ld <br /> ❑ ❑ e <br /> ❑ ❑ t/Vermin <br /> Struct operation isposalval from Premises <br /> ❑fractureOperation posal❑ c stem❑ ❑ . ewer <br /> Structure Operation Rabies Vaccination R EIVED INSPECTO <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />