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SAN JOAQUIN COUNTY <br /> z' Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. 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 /> 9�/FpRta <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA I INSPECTION DATE <br /> Structure Operation Water Well \ t l- -12- <br /> 11 <br /> LZ❑ ❑ 1. Y(clU206dction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Ck- -Connection -7 " f N <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ [13. Spreading and Disking i � Jt t <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning421� 'C/41Jrca�- <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 'n ✓V <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control J <br /> ❑ ❑ 10. Domestic Fl +- L ti <br /> ❑ ❑ ll. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. i ht Po ulati n <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure operation Feeding/Water t <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls C <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses L y` (' ^/" .1� <br /> ❑ ❑ 21. <br /> ❑ ❑ 22(' 11 tT`-'- \ <br /> ❑ ❑ 23. Cleato <br /> KENNEL <br /> Structure Operation I Water Well <br /> ❑ ❑ 1. 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 /> ❑ ❑ 7. Cleaning FrequencyhP�t t/l.Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition 1'1,IZ ISS <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. InsectfVermin r'i dl C;i\,I I°trG� i✓VC <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal j- - U L•�n (�J Om <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination E rBVYj IN E OR q n, <br /> ❑ <br /> El 18. Certificate on Premises 1 ,�(�4 � -l"Gr' 1 <br /> EHD 40-06 6/30/2005 Page_of Zi <br />