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SAN JOAQUIN COUNTY <br /> ,o •• caG <br /> Q= N? EN ONMENTAL HEALTH EPARTME <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 /> �/FpR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation <br /> Water Well f <br /> ❑ ❑ 1. Well Construction PREmisif ADDRESS REINSPECTION DATE <br /> 1-1 ❑ 2. Cross-Connection 5<3 C7 .� <br /> Struct a Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ 3. Sprea ng and Disking ����t, -1 b 033 <br /> ❑ 4. Corfrete Tanks INSPECTIO TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. ooning �,A cam ' A 1,1,0005-5- <br /> ❑ C1 6. mposting The items below represent code violations and must be corrected: <br /> Structure Operation Bi/d Disposal <br /> 1: ❑ 71 Burying with 2"of Cover <br /> 11 ElA roved Concrete Tank <br /> 1:3 ❑ Removal from Premises t iCki <br /> Structure Operation ctor Control <br /> El El 10\Domestic Fl <br /> ElEl11. annia Fl <br /> ❑ ❑ , 12. rvae ock <br /> El of 13. Aa <br /> ❑ 14. Ad u e-" t� l�� <br /> ❑ 15. Li ht o ulation <br /> ❑ 16. Moder e Population <br /> ❑ ❑ 17. HeavyP ulation <br /> Structure Operation Feeding/Wat <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or BoAs <br /> ❑ ❑ 20. Food Stora e <br /> e <br /> Structure Operation Houses moi)" I <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s l l f 9 <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection �p <br /> Structure Operation Floors <br /> ❑ El 3. Properly Graded to 1 <br /> El El 4. Drain / <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin h <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Fre uenc <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> El ❑ 14. Removal from Premises <br /> 11 ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination I-R-HoffikD B INSP O <br /> ❑ ❑ 18. Certificate on Pre <br /> EHD 40-06 6/30/2005 Page of <br />