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P " SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> *`V Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> a�FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA 1 INSPECTION DATE <br /> Structure Operation Water Well [ r <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS f REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection , 1 a� <br /> Structure Operation Manure Management 01 R PHONE <br /> ❑ ❑ 3. Spreading nd Disking <br /> ❑ 4. Concrete riks INSPECTION TYPE-' PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagoo ng <br /> ❑ 6. Com sting The items below represent code violations and must be correcte <br /> Structure Operati Bird sposal <br /> ❑ ❑ 7. Wrying with 2"of Cover <br /> ❑ ❑ 8-Approved Concrete Tank <br /> P <br /> ❑ ❑ Removal from Premises , n <br /> Structure Operation Avector Control <br /> ❑ ❑ . Domestic FI psi <br /> 11 El I k Fannia Fl <br /> 12. Larvae <br /> ❑ 13. u ae <br /> f <br /> ❑ 14. A ult J G. <br /> ❑ 15. Likht Po ulation <br /> ❑ 16. MAPrate Population y4y, 4A1nP'%4 <br /> I <br /> ❑ 17. Heav Po ulation <br /> ure peration Feeding/ ter 18. Water ou hs <br /> 19. Cups or wls <br /> ❑ 0 20. Food Stora e <br /> p t t <br /> Structure Operation Houses /j2b1�1 <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 1 22. Walls/Ceilings <br /> ❑ 1 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well a <br /> ❑ ❑ 1. Well Construction Eced <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> • ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Coving (4) &el It n -c-Ij C�'d <br /> ❑ El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ El10. Condition i, <br /> 11 El 11. Sanitation <br /> Structure Operation Food c <br /> 12. Storage <br /> ❑ El 13. Insect/Vermin <br /> Structure Operation Animal Disposal n <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ El 16. Septic System <br /> ❑ ❑ 17. Sewer ltt� OtPm S� <br /> Structure operation Rabies Vaccination CEI D BY INSP OR <br /> ❑ ❑ 18. Certificate on Premises an I <br /> EHD 40-06 6/30/2005 Page Of <br />