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SAN JOAQUIN COUNTY <br /> _,•t v �Z <br /> ger ENVIRONMENTAL HEALTH DEPARTM T <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Far:(209)464-0138 Web:www.sjgov.org/ehd <br /> a(7 9q, VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTI N DA E/A,^Xl <br /> Structure Operation Water Well Cr rel e- e n h e'-✓ 215 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS �` j.t REINSPECTIO DATE <br /> ❑ ❑ 2. Cross-Connection 316 l �7 S r 1 ra� e1 V d <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE [� <br /> 1:1 El 3. Spreading and Disking K(lv-r V C�/1 9 35-b-7&V <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 11 El5. Lagooning 1 Lf`I,IS V P Q 0 4 <br /> ❑ ❑ 6. Compostingj The items below represent code violations and must be corrected: <br /> Structure operation Bird Disposal Note <br /> ❑ ❑ 7. Burying w th 2"of Cover I`t't7C s <br /> ❑ ❑ 8. Approvei ApproveConcrete Tank �� .n �c S <br /> 11 Elt <br /> 9. Remov from Premises r <br /> Structure Operation Vector ntrol n � ��� IVw <br /> ❑ ❑ 10. D estic FI '�'. • <br /> ❑ ❑ 11. F nnia FI <br /> ❑ ❑ 12. rvae <br /> ❑ ❑ <br /> I/ Pupae ^^�� ggo�ry c '^ �n r <br /> ❑ ❑ 4. Adult L �� V V�J i,1 4 1 e I clean . <br /> ❑ ❑ j 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. ing/ atPopulation rzC 1 s qre Cu V- <br /> e� ^N d <br /> Structure Opera on Feeding/Water V ayl <br /> ❑ 18. Water Troughs <br /> 11 Yl 19. Cups or Bowls LAPplq fe k (d <br /> ❑ ❑ 20. Food Stora <br /> Structure Operation Houses .Q.. pe, 0,+ y V cc. e C.Q <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23.K E N NCEea�nin Frequency C,� good <br /> j 1 0-k\ • <br /> Structureri&O.Remtion Water Well V� l <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection A� o r y _ ( `� i S f��fn Jy j ��', <br /> Structure ration Floors J"` (� lel r ► 1( t <br /> ❑ ❑ 3. Properly Graded to jqv <br /> /� / ♦j/ t <br /> ❑ ❑ 4. Drain + 1 V 1 1�' cI ( t✓l,.r k.- • <br /> ❑ ❑ 5. Smooth/Cleanable V C 1 Cc r'Q� (at <br /> El ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation1 (/i /� c> <br /> Structure Operation Food N o (OL, �Isr `v L. <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Opention Sewage Disposal <br /> ❑ ❑ 16. Septic System Laos , <br /> ❑ 17. Sewer `: l(J <br /> Structure Operation Rabies Vaccination RECEI Y I T <br /> El lop18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of 1 <br />