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JAN JOAQUIN COUNTY <br /> ON',�$ ENVIRONMENTAL HEALTH DEPARTME T <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> t_. Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> Q�FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE TION DATE <br /> I ,,Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE AD RESS / REI PEC N DATE <br /> El 132. Cross-Connection4!541 <br /> Structure Operation Manure Manag entW OPERATOR / PHONE <br /> E] E] 3. Spreading a Disking i,'le- <br /> ❑ ❑ 4. Concrete T nks INSPECTION TYPE I I PRO RAM ELEMENT RECORD ID ii <br /> ❑ 5. Lagoonin l <br /> ❑ 11 6. Composing The items below represent code violations and must be corrected: <br /> Structure Operas n Bird DIS Sal <br /> ❑ ❑ 7. Bu i with 2"of Cover <br /> ❑ ❑ 8. A ved Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises t� <br /> Structure Operation Vec r Control <br /> ❑ ❑ 0. Domestic FI <br /> ❑ ❑ 1 . Fannia Fl <br /> ❑ ❑ Larvae v-- <br /> ❑ ❑ 13.Vpae <br /> El ❑ If 14. Ndult <br /> ❑ El If 15. L ht Population <br /> ❑ ❑ If 16. M erate Population <br /> ❑ 17. HeaV Population <br /> Structure Ope tion Feeding/ ater <br /> ❑ 18. Water ou hs <br /> ❑ ❑ 19. Cups or owls <br /> ❑ ❑ 20. Food Sto ge <br /> Structure Operation Houses Lf) � d ,y t'°'/� ea I ar <br /> ❑ ❑ 21. Floors <br /> ❑ 1 ❑ 22. Walls/Ceilings C0 i 14b, <br /> ❑ 1 ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> r <br /> ❑ ❑ 4. Drain I <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ El 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> 11 0 16. Septic System <br /> 11 ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination EC IV B INSPE R <br /> ❑ ❑ 18. Certificate on Premises <br /> ] A )AA <br /> EHD 40-06 6/30/2005 Page of I_ <br />