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,o cQG SAN JOAQUIN COUNTY <br /> 2. w ra <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fan: (209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBApp INSPECTION DATE <br /> Structure Operation Water Well f� i °m17, <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> t <br /> ❑ ❑ 2. Cross- onnection <br /> Structure Operation Manure/ anagement ®WNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spr ading and Disking -1 <br /> ❑ 4. C crete Tanks INSPECTIttONr E PROGRAM ELEMENT REP <br /> E RD ID <br /> ❑ 5. JAgooning <br /> ❑ [16./Composting The items below represent code violations and must be corrected: <br /> Structure Operation rd Disposal <br /> ❑ ❑ Bu in with 2"of Cover <br /> ❑ 8. Approved Concrete Tank I° y I <br /> co <br /> ❑ 9. Removal from Premises / Y� <br /> Structure Operas Vector Control 1 <br /> ❑ ❑ 10. Domestic Fl 1�1 <br /> ❑ 11. Fannia Fly Qj <br /> ❑ Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. dint l 1 <br /> ❑ ❑ 15. Li6t Population <br /> ❑ ❑ 16. Mo rate Population <br /> ❑ ❑ 17. Heavyo ulation <br /> Struct a operation Feeding/W er <br /> ❑ 18. Water Tr hs <br /> 19. Cups or Bo Is <br /> S <br /> ❑ 20. Food Stora <br /> r <br /> ructure Operation Houses t <br /> ❑ ❑ 21. Floors <br /> ❑ El 22. Walls/Ceilin s <br /> ❑ 23. Cleaning FM=L- <br /> e uenc a q <br /> KENNEL fib <br /> Structure operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain o <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. CleaningFre uenc <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> 11 ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ 0 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure I operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> El ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVE INSPE OR <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />