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oP°u t" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> S(•o.3t! �vk rim {,.•� <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> " Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> q Ci�o:R ci <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSP CTION DATE <br /> Structure Oper ion Water Well C ). <br /> ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Co nection '+0 yzarx <br /> Structure Operati Manure M nagement OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spread' g and DiskingVA)114 <br /> ❑ ❑ 4. Conc to Tanks INSPECTIOV TYPE PROGRAM ELEMENT CORD ID <br /> ❑ ❑ 5. Lag oning <br /> ❑ ❑ 6. C9(-posting The items below represent code violations and must be corrected: <br /> Structure Operation it Disposal <br /> ❑ ❑ 7VBurying with 2"of Cover <br /> ❑ ❑ roved Concrete Tank <br /> r <br /> ❑ ❑ 9. Vemoval from Premises <br /> Structure Operation VeC r Control <br /> ❑ ❑ 10. omestic FI <br /> ❑ 0 L 11. F nnia FI <br /> ❑ ❑ 12. La ae rt 1 <br /> ❑ ❑ 13. Pu e / <br /> ❑ 14. AduN <br /> ❑ 0 15. Li ht o ulation <br /> ❑ 16. Moder to Population <br /> ❑ 4419. <br /> 17. Heavyulation g <br /> StructureFeeding/Wat r ®�+ <br /> ❑ 18. Water Tro hs <br /> ❑ Cu s or Bo s <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ 0 21. Floors P <br /> ❑ ❑ 22. Walls/Ceilings 9 r <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ 2. Cross Connection r <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Coving Nczuiolnfl <br /> ❑ ❑ 7. Cleaning Frequency <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 I Food <br /> 11 El 12. Storage <br /> 11 ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ El 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> 11 El 16. septic system <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIV INSPECT <br /> 11 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Pageof <br />