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SAN JOAQUIN COUNTY <br /> EN TRONENTAL EALTHEPARTME `T <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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA r INSPECTION DATE <br /> Structure Operation Water Well i �� '' <br /> 5 - <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS �^ j y REINSPECTION DATE <br /> El 2. Cross-Connection LE- C -�! 611 <br /> Structure Operation Manure Management [INPSPECTION <br /> OPERATOR PHONE f f <br /> ❑ ❑ 3. Spreading and Disking <br /> 4. Concrete Tanks T PE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning I <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 <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control @ ,. <br /> El El 10. Domestic Fl / 1 <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ El 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population } <br /> ❑ ❑ 16. Moderate Population ! s <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls 121A(--bb- <br /> 11 <br /> ®' <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses � <br /> ❑ El 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings w Q <br /> ❑ 1 ❑ 1 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction vau. <br /> ❑ 1, 0 2. Cross Connection <br /> P <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Grade o <br /> ❑ NO 4. Drain to 3 A <br /> 0 N1 5. Smooth/Clea able <br /> ❑ 6. Coving e <br /> ❑ ❑ 7. Cleaning re uenc <br /> Structure Operado Walls <br /> ❑ ❑ N 8. Smo Cleanable <br /> El . Cle in Frequency <br /> Structure Operation g 1 <br /> El El10 Condition 6 <br /> ❑ ❑ anitation <br /> Structure Operation ood <br /> 1:112. Sto e <br /> 13. Inse Vermin <br /> Structure OperatiA Animal D posal <br /> ❑ 14. <br /> Rem <br /> ov 1 from Premises <br /> El15. Other <br /> Structure O ration Sewage Disp al <br /> ❑ El 16. Septic S st <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccinati 11 RECEIVED BY INSIDE <br /> T <br /> ❑ 18. Certificate on Oremises i <br /> EHD 40-06 6/30/2005 Page Of <br />