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EHD 40-06 6/30/2005 u I J Page -L Of -L <br />.TOA UIN COUNTY <br />SAN C <br />Q 40 <br />DBA <br />I/t yA IT Pricib <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br />Structure Operation Water Well <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SFO, <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 u I J Page -L Of -L <br />POULTRY RANCH <br />DBA <br />I/t yA IT Pricib <br />INSPEC IONDTE <br />' V <br />Structure Operation Water Well <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS J� <br />& bo s Rd <br />REINSPECTION DATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Manageme t <br />OWNER/OPERATOR <br />HON <br />❑ ❑ 3. Spreading and 4king <br />❑ <br />❑ <br />4. Concrete TankINSPECTION <br />TYPE <br />R ,'TyJ1Afll�l.�) <br />PROGRA/M/ELEMENT <br />"J <br />[CORP ID /� <br />PP* oC) <br />❑ ❑ 5. Lagooning <br />❑ <br />❑ <br />6. Compostin <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Dispo3 1 <br />/y <br />fN 1/ �,r 6r l �i , V • rW 1�. 1K n 1 �L S <br />❑ ❑ 7. Bu in with 2" of Cover <br />❑ <br />❑ <br />8. A r ed Concrete Tank <br />c <br />f e <br />❑ 9. Re val from Premises <br />11�I�W <br />Structure <br />Operation <br />vecto Control <br />❑ ❑ 10. omestic Fl <br />❑ <br />❑ <br />1 1 Fannia FI <br />j ' � h Q� 5 ay, 14? - <br />Q❑ <br />❑ ❑ A. Larvae <br />0 <br />❑ <br />l3. Pupae <br />.�j� Q"�- <br />2 o 1 Vr I DLY Uok ,Key's <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />3 Dhe 0 ZP l /Orl �r S / <br />1:1l6. Moderatate Po ulation <br />❑ <br />17. Heavy Population <br />/� Q <br />5le,� <br />Structure ration Feeding/Water <br />❑ <br />❑ <br />18. Water Trohs <br />! J' 1.��.s ae-t' dea A d . Lqs <br />❑ ❑ 19. Cups orr Bo Bowls <br />❑ <br />❑ <br />20. Food Storage <br />' I y /1 A <br />n d- IC/V'C/7 v a- <br />Stra re Operation Houses <br />❑ <br />21. Floors <br />/�� b a.- n i d .� ��� <br />tM l <br />11 1122. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency <br />n �c <br />`K� vt e J <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />,'�j� �/` <br />as , --e- �w' v • 4-S <br />El 1. Well Construction <br />❑ <br />❑ <br />Cross Connection <br />e O D �" <br />Structure Operation Floors <br />F <br />❑ <br />❑ <br />3. Properly Graded to <br />V-0 v <br />El El 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />�. <br />11❑ 6. Covin <br />❑ <br />❑ <br />7. Cleaning Frequency <br />C <br />(/�� l (J w V �i,jJ J <br />Structure Operation Walls <br />❑ <br />❑ <br />8. Smooth/Cleanable <br />recOr _^ I, M n D f ar `� I e <br />a YV ` <br />Frequency <br />❑ ❑ 9. Cleanin Fre uenc <br />Cleaning <br />Structure <br />Operation <br />Cages <br />^ tV / � C <br />� 0 <br />kav e n o-� W ( eV , � s <br />❑ ❑ 10. Condition <br />❑ <br />❑ <br />11. Sanitation <br />I m " V, 7�> V <br />Structure Operation Food <br />❑ <br />❑ <br />12. Storage <br />❑ ❑ 13. Insect/Vermin <br />Structure <br />operation <br />Animal Disposal <br />0 / <br />/v��/ "per /✓y" <br />14. Removal from Premises <br />11 Elry <br />❑ <br />❑ <br />15. Other <br />'U S �Va %"'� I <br />ORV i <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />16. Septic System <br />❑ ❑ 17. Sewer <br />Structure <br />operation <br />Rabies Vaccination <br />RECEIVE <br />%� <br />INS <br />❑ El18. Certificate on Premises <br />EHD 40-06 6/30/2005 u I J Page -L Of -L <br />