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SAN JOAQUIN COUNTY 10 <br /> R. ENVIRONMENTAL HEALTH DEPARTMENT <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 /> QEF®Ra <br /> VECTOR CONTROL INSPECTION FORM <br /> P O U L T R Y RANCH DBA ) / INSPECTION DATE <br /> Stru ure Operation Water Well 't✓8 }q l .�"("�.i or t- <br /> ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 1 h <br /> Structure Operation Manure Management OWN OPERATOR / PHONE (� <br /> ❑ El3. Spreading and Disking �r`eav� /4-[ t <br /> [3 ❑ 4. Concrete Tanks <br /> INS P TION TYPE PROGRAM ELEMENT RECORD ID <br /> 11 \C1 5. Lagooning mac PR ,y 15 <br /> ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Ope ion Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank Z <br /> El El 9. Removal from Premises ®��11 q' <br /> Structure Operation Vector Control <br /> ❑ ❑ 0. Domestic Fl <br /> ❑ ❑ I Fannia Fl <br /> El 12. Larvae r / 1� <br /> ❑ ❑ 13.Vpae <br /> ❑ ❑ 14. Ault <br /> ❑ ❑ 15. Li t Population <br /> ❑ ❑ 16. Mo rate Population <br /> ❑ 17. Heav Po ulation <br /> r <br /> Structure Operation Feeding/ ter <br /> ❑ 0 18. Water T u hs <br /> ❑ 19. Cups or wls <br /> 11 0 20. Food Stora <br /> Structure Operation H®use$ <br /> ❑ ❑ 21. Floors <br /> t <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ El 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ 11 1. Well Construction <br /> ❑ ❑ 2. Cross Connection 1 <br /> Structure Operation Floors NO <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El ❑ 6. Covin <br /> 11 ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ El 11. Sanitation <br /> Structure Operation Food <br /> ❑ 11 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 /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies VaccinationCEIV D BY INSPECT <br /> ❑ ❑ 18. Certificate on PremisesiL22 <br /> EHD 40-06 6/30/2005 Page Of <br />