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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> �h < <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 /> FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA n INSPECTION DATE <br /> Structure Operation Water Well rG <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cros`Connection 4 OfAro , <br /> Structure peration Man Uri Management OWNER/OPERATOR PHONE <br /> ❑ I <br /> 3. Sp eading and Disking <br /> ❑ 4. ncrete Tanks INSPECTION PE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. gooning <br /> ❑ composting The items below represent code violations and must be corrected: <br /> Structure Ird Disposal <br /> ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ 9. Removal from Premises f Med <br /> P <br /> Structure Operat' n ector Control 4 <br /> ❑ El I k Domestic Fl <br /> ❑ 4 1 1. Fannia FI <br /> ❑ 10 12. Varvae <br /> ❑ ❑ 13. Npae <br /> ❑ ❑ 14. A It Sri <br /> ❑ ❑ 15. Li t Population <br /> ❑ ❑ 16. Mod ate Population <br /> ❑ 1 ❑ 17. HeavyVopulation <br /> Structur Operation Feeda ng�W er <br /> ❑ ❑ 18. Water Tru hs <br /> ❑ ❑ 19. Cups or BIlwls <br /> El 20. Food Stora <br /> Struc ure Operation Houses <br /> ❑ ❑ 1 21. Floors {{ <br /> ❑ ❑ 1 22. Walls/Ceilings C7 !� <br /> ❑ 123. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ 0 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain421 72 <br /> 11 ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> 11 El 8. Smooth/Cleanable <br /> ❑ 0 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ 12. Storage <br /> ❑ 0 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> 11 ❑ 14. Removal from Premises <br /> ❑ El 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination R EIVE Y INSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />