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p U 1 k SAN J ACJI COUNTY <br /> ,pP �,i... C,p... ..;. .. ......... __ _ _. . <br /> ENV RONMENTAL HEALTH DEPARTMEIT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> q Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ;P <br /> cq{rFOF^"' <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA , INSPECTION DATE ray <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ jj 1 2. Cross-Connectio rS i <br /> Structure opera'on Manure manageint OWNER/OPERATOR llyy PHONE <br /> ❑ ❑ 3. Spreading an isking lr�e� 'Ttnt ti <br /> 1:1 [:] 4. Concrete T ks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El [1 . Lagooni L� tA�t <br /> ❑ ❑ 6. Comp sting The items below represent code violations and must be corrected: <br /> Structure Operation B1 sposal <br /> ❑ ❑ 7. FXrying with 2"of Cover <br /> ❑ ❑ I 8/Aplroved Concrete Tank <br /> a <br /> El ElRem val from Premises r 1 e- �t <br /> Structure Operation Vector kntrol <br /> ❑ 0 10. Dom tic Fly a <br /> ❑ ❑ 11. Fannia 1 <br /> ❑ Ey 12. Larvae <br /> ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Po ula'on 9 <br /> ❑ ❑ 16. Moderate Po lation <br /> ❑ 17. Heavy Po ulati n <br /> Struc re Operation Feeding/Water �` <br /> ❑ 18. Water Troughs <br /> ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequenc <br /> K E N N E L �-- �� 3°�P/� 0 0i <br /> Structure Operation Water Well <br /> i <br /> ❑ 0 I. Well Construction d C�I T <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to yy <br /> 11 11 4. Drain LJ9 t tl <br /> ❑ El 5. Smooth/Cleanable <br /> ❑ ❑ 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 /> ❑ ❑ I1. 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. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure operation Rabies Vaccination EC V INSP O <br /> ❑ 0 1 18. Certificate on Premises <br /> 'HD 40-06 6/30/2005 Page Of <br />