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ENISAN JOAQUIN COUNTY <br />ONMENTAL HEALTH DEPARTMEV <br />304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br />Telephone. (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 1 <br />Page j of -4 <br />POULTRY RANCH <br />DBA 4 <br />"DOLnd F <br />INSPECTION ATE <br />Structure <br />Operation <br />Water Well <br />C'r- <br />11 <br />El <br />1. Well Construction <br />PREMISE ADDRESS <br />REINSPECTION DATE <br />0 <br />El <br />2. Cross -Conn tion <br />-Zj(--!577 f2j <br />Structure <br />Operation <br />Manure Ma gement <br />OWNER/OPERATOR <br />PHONE <br />1:1 <br />❑ <br />3. Spe.di4.nd Disking <br />Del-'jr.9- Fri, <br />1:1 <br />El <br />4. Concrek Tanks <br />INSPECTION TYPE -7 <br />PROGRAM ELEMENT <br />RECORD ID <br />11❑ <br />5. Lagoing <br />/n <br />I <br />L-f-q 5 �t <br />1:5-"'R0q6mC76* <br />0� <br />El <br />6. Co posting <br />The items below represent code violations and must be corrected: <br />Structu <br />Operation <br />Birdfiisposal <br />7. Ijurying with 2" of Cover <br />❑ <br />8. /Ap2roved Concrete Tank <br /><:31, , K <br />0 <br />\0 <br />9/ Removal from Premises <br />-f- ejS� ga <br />C' <br />a <br />Structure <br />OpNtion <br />Fector Control <br />El <br />Cj\ <br />I 10. Domestic Fly <br />12 <br />0 <br />0 V <br />11. Fannia Fly <br />El <br />El A <br />12. Larvae <br />11 <br />El / <br />\3. Pupae <br />1:1 <br />[7 <br />I\ Adult <br />&-e- <br />El <br />15.\Light Population <br />16. hoderate Population <br />El <br />0 <br />❑ <br />17. H v Population <br />Structure <br />Operation <br />Feeding)Vvater <br />0 <br />❑ <br />18. Water roughs <br />11 <br />[3 <br />19. Cups or owls <br />3) f2e, e, u,,, e . R re - <br />11 <br />20. Food Stor <br />Stru are <br />Operation <br />Houses <br />i rw <br />❑ <br />21. Floors <br />11 <br />❑ <br />22. Walls/Ceilings <br />11 <br />❑ <br />23. Cleaning FrequE2SL_ <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />11 <br />El <br />1. Well Construction <br />"o <br />1:1 <br />El <br />2. Cross Connection <br />Structure <br />Operation <br />Floors <br />0 <br />E] <br />3. Properly Graded to <br />0 <br />El <br />4. Drain <br />jff" <br />CA2 <br />F1 <br />0 <br />5. Smooth/Cleanable <br />n <br />El <br />6. Coving <br />El <br />0 <br />7. CleaninFrecluency <br />Structure <br />Operation <br />Walls <br />0 <br />El <br />8. Smooth/Cleanable <br />11 <br />El <br />9. Cleaning Frequency <br />Qicdo,4-iov�-5v <br />Structure <br />Operation <br />Cages <br />❑ <br />0 <br />10. Condition <br />El <br />El <br />11. Sanitation <br />Structure <br />Operation <br />Food <br />11 <br />0 <br />12. Storage <br />El <br />1:1 <br />13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />0 <br />14. Removal from Premises <br />❑ <br />El <br />15. Other <br />Structure <br />operation <br />Sewage Disposal <br />11 <br />11 <br />16. Septic System <br />El <br />0 <br />17. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEIVED BY zz INSPECT1-Y <br />0 <br />El <br />18. Certificate on Premises <br />--A <br />EHD 40-06 6/30/2005 1 <br />Page j of -4 <br />