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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM T <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 �f INSPECT17 <br /> I N DATE <br /> Structure Operation Water Well L►. Pea Aloas Z_ f 0:7 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS , REINS CTION ATE <br /> ❑ ❑ 2. Cross-Connection v <br /> Structure Operation Manure Management Ow OPERATOR PHONE <br /> ® C <br /> ❑ ❑ 3. Spreading and Disking s� <br /> ❑ ❑ 4. Concrete Tanks IN TION TYPE PROGRAM ELEME T RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation vector Control <br /> ❑ ❑ 10. Domestic Fl 6 s <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> 130 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ 18. Water Trou hs t <br /> ❑ ❑ 19. Cups or Bowls <br /> 11 D 20. Food Stora e <br /> Structure operation Houses47 <br /> ❑ El21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ 1 ❑ 23. Cleaning Frequency <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 /> Cl ❑ 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 /> ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ 0 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 /> ❑ ❑ 16. Septic System <br /> ❑ 0 17. Sewer <br /> Structure Operation Rabies Vaccination RECED BY I O <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of_ <br />