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®Po u I N c SAN JOAQUIN COUNTY 0 E ONMENTAL HEALTH EPARTM ' 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 Telephoner(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd C �Q qui F_OR� VECTOR CONTROL ONTL y S LCryTON FORM POULTRY RANCH DBA INSPECT NDA t Structure Operation Water Well S i ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSOECTioA DATE s 11 2. Cross-Connection t Structure Operation Manure Management OWNER/OPERATOR PHO ❑ ❑ 3. Spreading and Disking S Cy A + / ❑ ❑ 4. Concrete Tanks USPECTIONTYPE PROGRAM ELEMENT RECORD ID ❑ ❑ 5. Lagooning �- ❑ ❑ 6. Composting The item below represent code violations and must be corrected: Structure Operation Bird Disposal 11El7. Burying with 2"of Cover 11 8. Approved Concrete Tank ❑ 9. Removal from Premises s Structure Operation Vector Control ❑ ❑ 10. Domestic Fly ❑ ❑ 11. Fannia FI ❑ ❑ 12. Larvae a ❑ ❑ 13. Pupae ❑ ❑ 14. Adult ❑ ❑ 15. Light Population , 11 1:116. Moderate Population L ❑ ❑ 1 17. Heavy Population Structure Operation Feeding/Water ❑ ❑ 18. Water Troughs ❑ ❑ 19. Cups or Bowls ❑ 20. Food Storage Structure Operation Houses ❑ 1 0 21. Floors ❑ 22. Walls/Ceilings 51 ❑ ❑ 23. Cleanin Fre uenc � a KENNEL Structure Operation Water Well ❑ ❑ L Well Construction t ❑ ❑ 2. Cross Connection Structure Operation Floors ❑ ❑ 3. Properly Graded to ❑ ❑ 4. Drain ❑ ❑ 5. Smooth/Cleanable Apll 11 ❑ 6. Covin �TAdes ❑ 11 7. Cleaning Frequency .� Structure Operation Walls ❑ ❑ 8. Smooth/Cleanable ❑ ❑ 9. Cleaning Frequency Structure Operation Cages r ❑ El 10. Condition ❑ ❑ 11. Sanitation Structure Operation Food t r ❑ ❑ 12. Storage ❑ ❑ 13. Insect/Vermin Structure Operation Animal Disposal ❑ El 14. Removal from Premises ❑ 11 15. Other Structure Operation Sewage Disposal El 11 16. Septic System ❑ ❑ 17. Sewer Structure Operation Rabies Vaccination RECEIVED BY INSPECTOR ❑ ❑ 18. Certificate on Premises a Q 4b EHD 40-06 6/30/2005 Page_of_