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p,O U t N SAN J OAQUIN COUNTY <br /> ` ? E IRONMENTAL HEALTH DEPARTM T <br /> _ 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> '9C%FpR� <br /> PT w 0 VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTI ND <br /> Structure Operation Water Well Af i,s Pet- •f IZ V V <br /> 11 <br /> ❑ 1. Well Construction PREMISE ADDRESS �� �� r REINSPECTION DATE <br /> 11 2. Cross-Connection 31110 <br /> Structure Operation Manure ManagVnent OWNER/OPERATOR PHONE (� <br /> ❑ ❑ 3. Spreading d Disking �01VI .-Vfk� 130 <br /> p ❑ 4. Concrete anks I PECTION TYPE PRONG/RAM ELEM NT RECORD ID <br /> ❑ ❑ 5. Lagoo ng i(, trl�t c "1 . )p 0 am <br /> ❑ ❑ 6. Conjosting The items below represent code violations and must be corrected: <br /> Structure Operation Bird isposal <br /> ❑ ❑ 7. u in with 2"of Cover <br /> ❑ ❑ 8 A roved Concrete Tank <br /> ❑ ❑ Removal from Premises 1 waft1 <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI G a <br /> ❑ ❑ <br /> It. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ 13. Pupae I I <br /> ❑ 14. Adult c, wcr 1 0 co�J'b o cA , ilon <br /> ❑ ❑ 15. Light Po ulation . <br /> ❑ ❑ 16. Moderate Population 4 <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> 11 Elt� <br /> 19. Cups or Bowls W q4cJ I S 1 S <br /> ❑ 20. Food Storage C( <br /> St cture Operation Houses f� 'I t-05'J 'Dn- <br /> ❑ ❑ 21. Floors <br /> ❑ 1 ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning FrequencyU 1 <br /> KENNEL -1 n1 a <br /> Structure Operation Water Well h_ <br /> El El 1. Well Constructions �f� O s S <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to i `,,/ <br /> 11 4. Drain ti) V q-V n(J,0 U Wjc- U <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. CleaningFre uenc \ , <br /> Structure Operation Walls Q (D\pi 1b, <br /> ❑ ❑ 8. Smooth/Cleanable 11 <br /> 11 El 9. CleaningFrequency v/ n r(n i <br /> Structure Operation Cages <br /> 1 <br /> El El 10. Condition V (,O ff ' <br /> ❑ ❑ 11. Sanitation \J <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 o` <br /> 11 ❑ 16. Septic System <br /> arn,t, �tv <br /> ❑ ❑ 17. Sewer \/ <br /> Structure Operation Rabies Vaccination C NE IN PECTOR <br /> t <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 VPage_of <br />