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ENV4SAN JOAQUIN COUNTY <br />1PONMENTAL HEALTH DEPARTMEV <br />304 East Weber Avenue, 3d 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 <br />DBA r <br />INSPE TION QT <br />Structure <br />Operation <br />Water Well <br />El <br />El <br />1. Well Construction <br />PREMIST-ADDRESS <br />00C)3 S- <br />REI ASPEC 14ON DATE <br />1:1 <br />0 <br />2. Cross -Connection <br /><�� I <br />Structure <br />Operation <br />Manure Management <br />OWNR/QPERATOR <br />[I <br />El <br />3. Spreading and Disking <br />14 <br />4. Concrete Tanks <br />INSPECTION TY <br />PRO RAM ELEMENT <br />RE ORD ID <br />❑ <br />5. Lagooning <br />El <br />6. Composting <br />The items below. represent code violations and must be corrected: <br />Structure <br />Operak- <br />Bird Disposal <br />11 <br />0 <br />7. Burying wiA 2" of Cover <br />El <br />11 <br />8. Approved/Concrete Tank <br />Cj <br />❑ <br />El <br />9. Removalfrom Premises <br />Structure <br />Operationector <br />ntrol <br />V <br />_ <br />i <br />d�q � <br />El <br />El <br />IV Dq(hestic Fly <br />'KK 0- 1 10 <br />El <br />0 <br />1 & Vnnia Fly <br />0 <br />012 <br />El <br />11ae <br />1-2 <br />❑ <br />14. Ault <br />El <br />0 <br />15. LiAt Population <br />11 <br />11 / <br />16. Mod 4ate Population <br />El <br />EY <br />17. HeavAopulation <br />Structure <br />OpAtion <br />Feeding/W!r <br />El <br />0 <br />18. Water Tro hs <br />11 <br />El <br />19. Cu s or Bo <br />11 1 <br />11 <br />20. Food Storage <br />Structure <br />Operation <br />Houses <br />❑ <br />0 <br />21. Floors <br />El <br />22. Walls/Ceilings <br />❑ <br />D <br />23. Cleaning FreSuency <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />11 <br />0 <br />1. Well Construction <br />0 <br />0 <br />2. Cross Connection <br />Structure <br />Operation <br />Floors <br />11 <br />1-] <br />3. Properly Graded to <br />0 <br />0-4. <br />Drain <br />11 <br />0 <br />5. Smooth/Cleanable <br />El <br />0 <br />6. Coving <br />11 <br />0 <br />7. CleaninFrequency <br />Structure <br />Operation <br />Walls <br />0 <br />0 <br />8. Smooth/Cleanable <br />11 <br />0 <br />9. Cleaning FLequency <br />Structure <br />Operation <br />Cages <br />F1 <br />El <br />10. Condition <br />0 <br />11 <br />11. Sanitation <br />Structure <br />Operation <br />Food <br />0 <br />El <br />12. Storage <br />11 <br />0 <br />13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />11 <br />0 <br />14. Removal from Premises <br />0❑ <br />15. Other <br />Structure <br />Operation <br />Sewage Disposal <br />11 <br />El <br />16. Septic System <br />11 <br />0 <br />17. Sewer <br />Structure <br />Operation <br />-Rabies Vaccination <br />RECEIVED BY <br />A41INSPECT <br />El <br />El <br />18. Certificate on Premises <br />EHD 40-06 6/30/2005 Page of / <br />&A " -/- -- <br />L�tblg-z%(a <br />