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p,®U I SAN JOA VIN COUNTY <br /> � j ENVIRONMENTAL HEALTH DEPARTME <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> m Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSP TION TE <br /> Structure Operation Water Well <br /> ❑ ❑ L Well Constructio PREMISE ADDRESS RE14SPECTfON DATE <br /> ❑ ❑ 2. Cross-Connecti n <br /> Structure Operation Manure ManaglKnent OWNERI(fPEkATOR PHONE <br /> ❑ ❑ 3. Spreading id Disking <br /> 11 ❑ 4. Concrete Yanks IN PECT10 TYPE PROD AM ELEM T RECORD ID <br /> 11 ❑ 5. Lagoon g Z)jA.VVV- ALqtwf I -i � P -70 5-j <br /> ❑ ❑ 6. comp ting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Di poral <br /> ❑ ❑ 7. B in with 2"of Cover <br /> ❑ ❑ 8. roved Concrete Tank Q a <br /> ❑ ❑ 9. emoval from Premises ! ` <br /> Structure Operation ector Control <br /> ❑ 10. Domestic Fly <br /> ❑ ❑ 1 L Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ 14. Adult ' C s <br /> W/Os or <br /> ❑ UO 15. Light Po ulation <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structureperation Feeding/Water <br /> 11 ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cu2s or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> (� ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequenc `� <br /> KENNEL 3t Fa� l Neo-41 vve v <br /> M0449-- <br /> structure Operation W er Well <br /> El ❑ 1. el onstruction a <br /> ❑ ❑ 2. Cross Connection <br /> Structur O ration Floors <br /> ❑ El3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleanin Fre uenc <br /> Structu /Operation Walls <br /> ❑ 0 ❑ 8. Smooth/Cleanable <br /> ❑ NJ ❑ 9. Cleaning Fre uenc <br /> Structure 1 Op tion Cages <br /> Jt' E] <br /> 10. Condition <br /> 11. Sanitation <br /> FOOd <br /> 12. Stora e <br /> 13. InsectlVermin <br /> Animal Disposal <br /> 14. l from Premises <br /> ❑ ❑ 15. Other <br /> Structure Aeration <br /> Disposal <br /> ❑ ❑ stem <br /> ❑ <br /> Structure operation Rabies Vaccination RE VED BY INSPE OR <br /> El 18. Certificate on Premises <br /> EHD 40- 6/30/2005 Page of <br />