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°'0 !��.ry SAN JOAQUIN COUNTY <br /> 2� 3.paaly 2 <br /> ENV RONMENTAL HEALTH DEPARTMEI T <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 /> •9�iFORt� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA ,/ /� ```` INSPECTION DATE <br /> Structure Operation Water Well 13 r ` er L ccbv-td V rs Z- 1-7 /0 <br /> ❑ ❑ 1. Well Construction PREMISE/ 1ADHDRE y / REINSATE <br /> 1:1 El 2. Cross-Connection If 6 -/ �� �Q� n%h R� ES CA1 U n <br /> Structure Operation Manure Management OWNER/OPERATOR <br /> � PHONE <br /> 11 ❑ 3. Spreading and Disking AM-\ R T R Y G t r �0`I '7523 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE /� PROGRAM ELEMENT /R�EpCORD ID ^� <br /> ❑ ❑ 5. Lagooning 01ch ru JT K"lil.o U 0 f"i 0 L d 0 +9' <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 <br /> ❑ ❑ 8. roved Concrete Tank R O L'f l r't %n S e d h S dttj'� + <br /> pp <br /> C3 ElR 9. Removal from Premises <br /> Structure Operation I Vector Control L <br /> El 10. Domestic FI J 0 L{ no-fed <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae / <br /> El 14. Adult e kL Yl e S (,1--z C t Q✓% <br /> ❑ ❑ 15. Light Population ^/ <br /> ❑ 1116. Moderate Population �VlC1.l � d <br /> ❑ ❑ 17. Heavy Population �1 t/, C' / p. {�}/ �) C <br /> Structure Operation Feeding/Water '' /V�{,/ ,-e dam.)i C"- t/ J 4l J <br /> ❑ ❑ 18. Water Troughs Welt <br /> ^ _r /; C <br /> El 1119. Cups or Bowls V V C� ke f L a V erect /vtQ- <br /> ❑ ❑ 20. Food Storage /� <br /> Structure Operation Houses AA't ' <br /> ❑ ❑ 21. Floors 7�1r <br /> El El 22. Walls/Ceilings re I/tiL o)-1 <br /> ❑ ❑ 23. Cleaning Frequency _ - n <br /> KENNEL '�r7 in o veirecd l d n1U-k%x('S <br /> Structure operation Water Well <br /> ❑ ❑ 1. Well Construction kzcard S at-e e&L I-,-e/� <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable J r ` <br /> 11 El 6. Covin 1" O V 10 1&,7 a-1.S k.Q !1-C1 <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ I ❑ 9. Cleaning Frequency <br /> Structure I Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System t� <br /> ❑ El 17. Sewer TerLttti �aw 96 l -2-q q <br /> structure operation Rabies Vaccination RE B <br /> ��. <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_I of <br />