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Po u t N C' <br /> SAN COUNTY <br /> �o <br /> 2' ENVIRONMENTAL HEALTH DEPART T <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> R Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> e1 <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH D INSPECTION DATE <br /> Structure Operation Water Well 19-11 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection t- <br /> Structure Operation Manure Management OWNER/OPERATOR HOE <br /> ❑ ❑ 3. Spreading and Disking l <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE (� PROGRAM ELEMENT EC RD ID <br /> 11 ❑ 5. Lagooning -ih c *o 4' Pk WILigj <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 s C ®s dde. Tht Follovi" <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises a <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ IL Fannia Fl <br /> ❑ 0 12. Larvae pt <br /> ❑ ❑ 13. Pupae 1 � 11 fl am �� �� 1� �-I� ✓, <br /> 11 El 14. Adult <br /> ❑ I5. Li ht Po ulation <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/W$terPods . <br /> ❑ ❑ 18. Water Troughs a f <br /> El 19. Cups or Bowls Qv-II 1 44 Fee-+. <br /> ❑ ❑ 20. Food Storage I <br /> n <br /> Structure Operation Houses Il �' `e ®i <br /> ❑ 21. Floors t <br /> ❑ ❑ 22. Walls/Ceilin s 1c ' nt <br /> ❑ ❑ 123. Cleaning Fre uenc e a a <br /> KENNEL I iS I <br /> Structure Operation Water Well 11 <br /> ❑ El 1. Well Construction <br /> ❑ 11 2. Cross Connection <br /> Structure Operation Floors poyla * No cOF AR4 a <br /> r <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain a v 1 f <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El6. Coving werockorts p I 4 D <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls AL&I <br /> o• Y, <br /> El ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency + tk S art V'iA h <br /> Structure Operation Cages <br /> El 1110 gCondition ,^ a <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food •t�1 Plam ei ` a <br /> • ❑ 12. Storage Ij <br /> ❑ ❑ 13. InsecvVermin P We AN b SUB M IT <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises 70 INCLUbG CLWEAT OPERA-flONSI <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic S stem 'e ®® b,urs eq <br /> ❑ ❑ 17. Sewer <br /> Structure Operation L18. <br /> ies�on <br /> RECEIVED Y INSPECTOR <br /> ❑ ❑ Ce <br /> EHD 40-06 6/30/2005 age ► of 1 <br />