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SAN JOAQUIN COUNTY - <br /> 4 ®�� ENVIRCI ENTAL 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 /> q�FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE nON 9ATE <br /> Structure Operation Water Well HD ICL4' I <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REI PECT1 N DATE <br /> ❑ ❑ 2. Cross-Connection f <br /> Structure Operation Manure ManaO <br /> ment OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading d Disking 1^r <br /> Lf 7c)--3473 <br /> ❑ ❑ 4. Concrete anks INS TION TYPE PR GRAM ELEMENT RECORD ID <br /> ❑ IQ 5. Lagoon g j <br /> ❑ 6. comp ting The items below represent code violations and must be corrected: <br /> Structure Operati Bird Dl sal <br /> ❑ ❑ 7. Bu ng with 2"of Cover <br /> ❑ ❑ 8. A roved Concrete Tank <br /> 11 ❑ moval from Premises <br /> Structure Operation Nvtor Control / <br /> ❑ El 1 . Domestic Fl / <br /> ❑ ❑ 11. Vnia Fl <br /> ❑ ❑ 12. La ae <br /> El ❑ 13. Pupa <br /> ❑ ❑ 14. Adult v <br /> ❑ ❑ 15. Light Po lation <br /> ❑ ❑ 16. Moderate Npulation <br /> ❑ ❑ 17. Heavy Po u tion <br /> Structure Oper ion Feeding/Water <br /> ❑ 18. Water Troughs <br /> ❑ 0 19. Cu2s or Bowls <br /> ❑ ❑ 20. Food Storage <br /> n <br /> Structure Operation Houses , <br /> 11 ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 4. Drain <br /> El 0 5. Smooth/Cleanable <br /> ❑ D 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> 11 ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ D 17. Sewer <br /> Structure Operation Rabies Vaccination R EI D B INSPECT <br /> LEl ❑ I8. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />