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P,9q.V!"Yc SAN JOAQUIN COUNT <br /> EN IRONMENTAL HEALTH DEPART 1✓NT <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 /> `FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSP CTION DATE <br /> Structure Operation Water Well Qe of f` CA <br /> ❑ ❑ 1. Well Construction PREMISE DRESS REINSPECT ON DATE <br /> ❑ ❑ 2. Cross-Connection I L41 I 5Aas",, <br /> Structure Operation Manure Management OWNERMPERATOR <br /> El 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RE R <br /> ❑ ❑ 5. Lagooning D-.- <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover to <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> El1 1. Fannia FI <br /> ❑ ❑ 12. Larvae v <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult VV C <br /> ❑ ❑ 15. Light Population /� <br /> 11 El 16. Moderate Population 11 O c c <br /> ❑ ❑ 17. Heavy Population <br /> Structure operation Feeding/Water L t3 v <br /> 011 18. Water Troughs <br /> 11 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage ( <br /> Structure Operation Houses " VVV t� <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. CleaninE Fre uenc <br /> KENNEL t k4, <br /> Structure Operation Water Well <br /> ❑ 0 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ 3. Properly Graded to <br /> 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequencye <br /> Structure Operation Walls L <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ 0 17. Sewer ^ <br /> Structure operation Rabies Vaccination I2EC / INSP CT R <br /> ❑ ❑ 18. Certificate on Premises tt <br /> EHD 40-06 6/30/2005 Page of_ <br />