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SAN JOA IN COUNTY <br /> 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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE TION DATE <br /> Structure Operation Water Well i' ` T- <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINslytcnog DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking CL <br /> ❑ ❑ 4. Concrete Tanks IN&PECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning ' Z 7 <br /> ❑ 6. Composting The items below represent code violations and must be correct : <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with Y'of Cover t <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises t <br /> Structure Operation Vector Control <br /> ❑ 0 10. Domestic Fl <br /> El ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae L O <br /> ❑ ❑ 13. Pupae <br /> 11 D 14. Adult \6 <br /> ❑ ❑ 15. Light Po ulation <br /> ❑ ❑ 16. Moderate Po ulation t <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water l L CL <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls + <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses w t- l <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings a� <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL ■ <br /> 40 <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors ( L ' <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain L 4 <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 /> ❑ 0 10. Condition oi D <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises i <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structore Operation Rabies Vaccination RE EIV B INSP OR <br /> ❑ ❑ 18. Certificate on Premises jAA <br /> EHD 40-06 6/30/2005 Page_of <br />