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SAN JOAQUIN COUNTY <br /> 10�COG <br /> ERONMENTAL HEALTH DEPARTM T <br /> NVI <br /> ✓raF? ; Stockton, CA 95202-z'�68' 6oQ ,�Gt.(J1 St. <br /> Telephone:(209)468-3420 Fax:(209)464-9+3$ Web:www.sjgov.org/ehd <br /> C���FpRa`P y�-0tlZq <br /> j0r* ® 0 0-7 3 VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA, ,�J/iA' (�� �/�{}/�(t/�t�/{1/�,bR (j`� (////���/i(T INSPECTI N DATE <br /> Structure Operation Water Well ) YV Y r t,-.l lV I" 'JJ ` !tea v VEC� IO ` O <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> El 2. Cross-Connection -�3 E, t <br /> Q� <br /> Structure Operation Manure Managem t OWNER/OPERATOR /y / rR ORE <br /> Q Q 1 (.� <br /> ❑ ❑ 3. Spreading and Asking l 1t.(1/ '�/' (J. _1/�' <br /> ❑ ❑ 4. Concrete T.As INSPECTION TY j��rr� PROGRAM ELEMENT [E�C/�ORD ID ^� <br /> ❑ ❑ 5. Lagoonin 1�OW ` flvl.a ��r e] 1'lC J 15'?1-1 <br /> ❑ ❑ 6. compo ng The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis sal <br /> ❑ ❑ 7. Bu ng with 2"of Cover <br /> ❑ ❑ 8. Anlroved Concrete Tank <br /> El El 9. <br /> ^ jvJ� � � �\ <br /> 9. moval from Premises 2 V off}, <br /> Structure Operation Vi-tor Control g� <br /> ❑ ❑ it. Domestic FI <br /> tl <br /> ❑ ❑ I. Fannia Fly 0 <br /> ❑ ❑ 12. Larvae <br /> El [313. /, �.ril/ .s o� lT/ <br /> 11 ❑ 14. Adult <br /> l T <br /> ❑ ❑ 15. Light Population <br /> ❑ C1 16. Moderate Population <br /> ❑ 17. Heavy Po ulation n r� <br /> Structure O ration Feeding/Water S / .ie t[ �J t/1; all <br /> ❑ ❑ 18. Water Troughs .�j� <br /> 11 El 19.19. Cups or Bowls da/he.- <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> 11 C1 21. Floors <br /> E01 ❑ 22. Walls/Ceilings 3art <br /> e/ i,l amd, m/et// <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ ell Construction <br /> ❑ ❑ 2. Cross Connection Lf. Foo A ' p, 60 <br /> Structure Operation Floors <br /> ❑ ❑ Properly Graded to <br /> ❑ ❑ 4. Drain co/'^ <br /> ► IS <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequencyr� �� / pA� <br /> Structure Operation Walls "v") eltoul <br /> � ` <br /> ❑ ❑ 8. Smooth/Cleanable 11 ❑ 9. Cleaning <br /> Frequency �` O F, in 6ad(jef:ed a <br /> Structure Operation .0 ges <br /> ❑ ❑ ondition oti Q OF 14/zi-k-lif <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation f9od, <br /> ❑ 11-4*_- forage <br /> El �0 V <br /> ❑ 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other �J A <br /> Structure operation 1,$epage Disposal <br /> ❑ ❑ e tic System <br /> ❑ ❑ 17. Sewer NJ'(i <br /> Structure Operation abies Vaccination E EIVE BY INSPECT <br /> ❑ ❑ Certificate on Premises U 14W4 <br /> EHD 40-06 6/30/2065 Page of <br />