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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d 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 nn ^^�� INSPECTION DATk'A <br /> Structure Operation Water Well (U^ Yr ��l - -/� &p <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ Elr 2. Cross-Connection 30&3& 2- Rd 7-/7-66 <br /> Structure Operation Manure Management OWNER/OPERATOR PH/O E J Q <br /> ❑ ❑ 3. Spreading and Disking7l <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE //��JJ���� t� PROGRAM ELEMENT /RAE ORD�IyD/�4 <br /> ❑ ❑ 5. Lagooning /Q' UI1CX��1' /t/"/t� <br /> Cl ❑ 6. Composting The Ulm below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal ,..�/ � n. hatted �' <br /> ❑ El7. Bu in with 2"of Cover n C' 1�1it�J dQ 1�)ium1� y�u <br /> ❑ ❑ 8. Approved Concrete Tank .} <br /> ❑ ❑ 9. Removal from Premises i. la�nt S s gels ale tyg ►7� <br /> Structure Operation Vector Control Weeds {� <br /> ❑ ❑ 10. Domestic Fl aoo ss blf�c 0 V cr r0 W n r ee"'`S v a,�' l��ntd <br /> ❑ ❑ 11. Fannia Fl n and <br /> r <br /> El Ele <br /> 12. Larvae es 4A q4h1d, lies a d moc `�J am <br /> ❑ ❑ 13. It Qn <br /> El ElA 14. Adult <br /> ❑ ❑ 15. Light Population <br /> 11 El16. Moderate Population aAJ �1 ry)dS-. <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups Or Bowls �espfGilr1- )s a as Sa nom ar <br /> ❑ ❑ 20. Food Storage ,.G�J /► L /la, LL n ►� �]� /}�, <br /> Structure Operation Houses Fbie 6c (et. Imo-- � l� W !1 t-�!• 'rh <br /> ❑ ❑ 21. Floors <br /> ❑ El 22. Walls/Ceilings VJQ.S Yff&C-f axct 4 f1DW K)CIV <br /> •wl�+�` '` <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well �j} y�� _ <br /> 11 C3 1. Well Construction y/ pbnv('S �e no� fall W � allo wi *b <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors Pyla ,r a/(timaak ojfn 4&jQs, "r a <br /> iVtC <br /> ❑ ❑ 3. Properly Graded to y� r <br /> [I111 r uR 4. Drain for m ci v^C s C&-ti o rrt fyLeo <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Coving frlDrfataq, aKd rnanar-e,. Evddeince of A b--- * <br /> 13 El 7. CleaningFrequency �r//IR( of -J v� I Q.r V 0-{ - "G1 '� <br /> Structure Operation We11S 'e+'v <br /> ❑ qq <br /> ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency qtS.a <br /> RI O fD S .>kP.+'I <br /> Structure Operation Cages V El El 10, Condition PON a S YT C® " yLE_F-C-Y PDOGOta- OR <br /> urSanitation <br /> Structure Operation Food <br /> rILLQ) V111TH WA� 4NV w, _ ,� /�E& Ak LY <br /> ❑ ❑ 12. Storage I� L pp VEAL �1{I1.IV�, ��IMV V r O <br /> ❑ ❑ 13. InsecWermin � � � r h� �'"� ��`-'U <br /> Structure operation Animal Disposal <br /> 11 El 14. Removal from Premises ht ; AMP, yST Q&& QcMoV b OR OD/ <br /> _ <br /> ❑ <br /> ❑ 15. Other <br /> Structure Operation Sewage Disposal r L^E 1-` & n <br /> W G/ 'BY 77 -1'7-06 o <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination REMID JU <br /> �/ I�,�I- CTOR „• a <br /> ❑ El18. Certificate on Premises W I /' <br /> EHD 40-06 6/30/2005 Page_Of , <br />