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P°"' SAN A COUNTY <br /> ,o c® <br /> O ENVIRONMENTAL 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 /> C a� eP <br /> .9�tF_a�C1 <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA /y INSPECTION DATE <br /> Structure Operation Water Well he.,:-S /- <br /> ❑ ❑ 1. Well Constructiov PREMISE ADDRESS REINSPECTION DATE <br /> ❑ 2. Cross-Connecti l i <br /> Struct a Operation Manure Manag ent wNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading a Disking +�- <br /> ❑ ❑ 4. Concretenks INSPEC ION TYPE PROGRAM ELEMENT RECORD ID <br /> E] [15. Lagooni nh /- faz r,)4.0006 <br /> - <br /> ❑ ❑ 6. Comp ting The items below represent code violations and must be corrected: <br /> Structure Op ration Bird DI sal <br /> ❑ N 7. Bu/ying with 2"of Cover <br /> ❑ a 8. 4proved Concrete Tank <br /> 11 ❑x 9. emoval from Premises <br /> Structure Operatio Victor Control <br /> ❑ ❑ 0. Domestic FI <br /> ❑ ❑ 11. Fannia Fly / / <br /> a' <br /> El 12. Larvae ! �tA .,1�1 <br /> ❑ E3 V. Pupae <br /> ❑ Ik Adult <br /> ❑ 15. Li ht Population ii P t <br /> 1116. oderate Population l f to <br /> ❑ ❑ 17. kavy Population <br /> Structure Operation Feedin Water <br /> ❑ ❑ 18. Wak Troughs <br /> ❑ ❑ 19. Cu s r Bowls t f <br /> ❑ ❑ 20. Food rage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> 8 <br /> El 22. Walls/Ceili s di r <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> a <br /> Structure Operation Floors L l t�'1/ <br /> - b"-S? <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> 11 ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure I Operation Cages <br /> 11 ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ El 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ 11 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVE BY INSPECT91 <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page I of <br />