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oP°"i" c SAN JOAQUIN COUNTY <br /> oG ENVIRONMENTAL HEALTH DEPARTMENI <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 /> QEF O R <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE ® <br /> Structure Operation Water Well q 0(0 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS f REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection a'( c <br /> structur Operation Manure Manage me OWNER/OPERATOR ® PHONE <br /> ❑ El 3. Spreading and D' king iml �� vi 6 1-3cf73 <br /> ❑ ❑ 1 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ to 6. Composting The items below represent code violations and must be corrected: <br /> Structure Oper 'on Bird Disposal <br /> ❑ ❑ 7. Burying w'h 2"of Cover <br /> ❑ ❑ 8. Approvedfc.ncrete Tank <br /> ❑ ❑ 9. Remov from Premises I <br /> Structure Operation Vector C ntrol <br /> ❑ El V Dotlestic FI <br /> ❑ ❑ 1 F nia Fl <br /> ❑ ❑ 12. rvae a <br /> 11 ❑ 13.Apae <br /> ❑ ❑ 14 A It <br /> El ❑ It Li Population <br /> ❑ ❑ 6. Mod ate Po ulation <br /> ❑ ❑ 17. HeavyVopulation <br /> Structure Operation Feeding/W er <br /> ❑ ❑ 18. Water Tr hs <br /> ❑ Ey 19. Cups or Bo Is <br /> ❑ 20. Food Stora <br /> Structure eration Houses �^ <br /> ❑ El21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> KENNEL <br /> StructureFEI <br /> Water Well <br /> 1. Well Construction 2. Cross Connection <br /> Structure Floors <br /> ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Fond <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 /> ❑ 0 16. Septic System <br /> ❑ LRabies <br /> Sewer <br /> Seructure ]OLpemfion Vaccination R I ED B INSPECTO <br /> El Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />