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pPO U t N' SAN JOAQUIN COUNTY <br /> a x" ENVIRONMENTAL HEALTH DEPARTMEO <br /> to :< <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 DBAit i INSPECTION DATE <br /> Structure Operation Water Well - <br /> ❑ ❑ I. Well Constru ton PREMISE ADDRESS REINSPECTION DATE <br /> 11Ll <br /> 2. Cross-Con ction w <br /> Structure Opel tion Manure M agement OWNE OPERATOR PHONE <br /> (� ,.. �� <br /> ❑ ❑ 3. Sprea ng and Disking <br /> ❑ ❑ 4. Co rete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. coning <br /> ❑ 6. omposting T e items below represent code violations and must be corrected: <br /> Structure Operation [rd Disposal <br /> ❑ ❑ A Burying with 2"of Cover <br /> ❑ ❑ 8.Vkpproved Concrete Tank <br /> ❑ ❑ 9. kmoval from Premises y� <br /> Structure Ope tion Veetkr Control <br /> ❑ 10. D mestic Fl <br /> ❑ <br /> 11. Fa is Fly / <br /> ❑ ❑ 12. LaAc /f �. <br /> ❑ ❑ 13. Pu a <br /> ❑ 14. Adult t-- <br /> ❑ 15. Li ht Po ulation <br /> ❑ 16. Moderate o ulation <br /> ❑ ❑ 17. Heavy Po lation <br /> Structure Operation Feeding/Water (����/ k) �.hycr� <br /> ❑ ❑ 18. Water Trou s <br /> ❑ ❑ 19. Cups or Bowl <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses rel <br /> ❑ ❑ 21. Floors <br /> ❑ 1 0 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ 13 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 11 El7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> 11 ❑ 10. Condition <br /> ❑ ❑ II. Sanitation <br /> Structure Operation Food <br /> ❑ 12. Storage <br /> ❑ ❑ 13. InsectlVermm <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic S stem <br /> ❑ El 17. Sewer <br /> Structure Operation Rabies Vaccination RE IVP BY INSPEC <br /> ❑ 18. Certificate on Premises r�i] �kl---' <br /> EHD 40-06 6/30/2005 y Page of <br />