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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEnT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> cq<i F o`a avP <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Struve'e Operation Water Well H 11r- L.Abrw,V,>� <br /> 1 0 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS ® REI SPECnON DATE <br /> ❑ ❑ 2. Cross-Connection 16-731 araXr <br /> Structure Operation Manure Management OW OPERATOR <br /> ❑ ❑ y I PHONE <br /> 3. Spreading and Disking 4e- -77-7 <br /> ' <br /> ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning 0 0 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operatio Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ t8. Approved Concrete Tank <br /> ❑ ❑ V Removal from Premises C <br /> Structure Operation ector Control } <br /> ❑ ❑ 1 Domestic Fl <br /> ❑ ❑ 1 1. annia Fl <br /> ❑ ❑ 12. karvae <br /> ❑ ❑ 13. Apae <br /> ❑ ❑ 14. A Ita <br /> t�+-d o I <br /> ❑ ❑ 15. LiA Population <br /> ❑ ❑ 16. Mod ate Population 4V <br /> ❑ ❑ 17. HeavyVopulation <br /> Structure Operation Feeding/W er <br /> ❑ ❑ 18. Water Tr u hs <br /> ❑ ❑ 19. Cups or B wls , <br /> 1:1 C320. Food Stora <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc ���/ <br /> K E N N E L oit7k-t- -a- <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 0 1 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> 11 ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> 11 0 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> El ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> 11 ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure operation Rabies Vaccination �RECI INSPEC <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />