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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 sI SP )TION ATE <br /> Structure Operation Water Well 1 S6-7 <br /> ❑ El 1. Well Construction PREMISEDRESS REI SPEC ION DATE <br /> El 2. Cross-Connection `1 <br /> Structure Operation Manure Managgoent OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading d Disking r <br /> ❑ ❑ 4. Concrete anks INSPECTI N TYPE PROGRAM ELEMENT RECORD ID <br /> El 115. Lagoon g i <br /> ❑ ❑ 6. Comp Sting The items below represent code violations and must be corrected: <br /> Structure Ope tion Bird 10posal <br /> ❑ ❑ 7. *ing*inwith 2"of Cover <br /> ❑ ❑ N, 8. roved Concrete Tank n <br /> ❑ ❑ . Removal from Premises �} <br /> Structure Operation ector Control <br /> ❑ ❑ I Domestic FI <br /> ❑ D I1. annia Fl <br /> ❑ 12. karvae <br /> ❑ 13. ae <br /> ❑ 14. A It C J <br /> ❑ ❑ 15. Lig t Population <br /> ❑ ❑ 16. Mod rate Population <br /> ❑ ❑ 17. Heavi Population <br /> Structur Operation Feeding/ at <br /> ❑ 0 18. Water troughs <br /> a <br /> ❑ ❑ 19. Cups okpowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses r <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well =� <br /> ❑ 0 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleaning Fre uenc <br /> Structure Operation Cages <br /> ❑ El 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RE DBY LJNSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 tPage of <br />