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P°"'" SAN JOAQUIN COUNTY <br /> Co <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W s „yrt <br /> AT < <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 /> C.• �P <br /> 9�F O R <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA, 1 INSPE TIOND E <br /> Structure Operation Water Well `.Ax�� 3-5 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS INSPECT N DATE <br /> ❑ ❑ 2. Cross-Connection DX 3 D 6 3-6 (4. +� <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE 2 <br /> 11 El 3. Spreading and Disking A \ .�\ �( �tiAPF <br /> "RIU) 55-b7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE U PROGRAM ELEMENT RECORDID <br /> 11 5. Lagooning .0k - / 49 4/A )XOJ&D <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal '� p <br /> ❑ ❑ 7. Burying with 2"of Cover V <br /> ❑ ❑ 8. Approved Concrete Tank , <br /> ❑ ❑ 9. Removal from Premises ?j 0 dd <br /> Structure Operation Vector Control <br /> 22p <br /> El 1:1l0. Domestic Fl �(- ._ "JS 60-0 <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae n 1/ <br /> 11 14. Adult _ J OJ <br /> ❑ ❑ 15. Light Population <br /> r�p� <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses v` <br /> ❑ ❑ 21. Floors <br /> t <br /> El 22. Walls/Ceilings s � ��O Qyv� � <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL eS. a_ <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction ,UTs vv-,4 e-- <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin lel Vtik" .f <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages � �r e <br /> ❑ El 10. Condition WlAY1e <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food �c7� 8•, <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin ry'_ + <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises S :2AC MkI 0 1^ C <br /> AT <br /> ❑ ❑ 15. Other �� /� <br /> Structure operation Sewage Disposal ( I'vv(/Vlit/t� A&D <br /> ❑ ❑ 16. Septic System <br /> El /� <br /> �{ <br /> ❑ 17. Sewer '' - ( <br /> Structure Operation Rabies Vaccination RECEIVED ` rNSVECfOR <br /> tl <br /> ❑ ❑ 1 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />