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oPqu l!y c SAN JOAQUIN COUNTY <br /> a EN ONMENTAL HEALTH DEPARTME <br /> `400E.Aih Per-A >te-3=-Feer, Stockton, CA 95202-2708 <br /> Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> '9(jF0'R C1 <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA °1 INSPECTO^yN D TE <br /> Structure Operation Water Well t'�h l )'( � / J t �+ ✓ I/f ? ( i <br /> 11 ❑ 1. Well Construction PREMISE ADDRESS J REINSPECTION DATE <br /> ❑ El 2. Cross-Connection I . R L:< 'J� <br /> Structure operation Manure Management OWNER/OPERATOR HO <br /> I t (Pj, <br /> ❑ ❑ 3. Spreading and Disking C1+ t a tit Y►yi G�t �(° l� ��s <br /> ❑ I ❑ 4. Concrete Tanks INSPECTION TYPE J PROGRAM ELEM T RECORD ID <br /> 11 ❑ 5. Lagooning �� 6, �t 1 aft <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 ,, 4 <br /> 11 El 9. Removal from Premises Ntp v! fa Ci i I l a 6 ki":2 C 1 to " P1 <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fly J J. '1 ti e i f` /� ✓1" Y t�J a 1 <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae Q✓ A Uh r 1?,4j<-tpm4gvr • <br /> ❑ ❑ 13. Pupae [ ( <br /> El 14. Adult I /a V �G a � T r,� ' � ,0 0110 15. Light Population <br /> ❑ ❑ 16. Moderate Population ✓ ' !� )1- <br /> ❑ ❑ 17. Heavy Population , y X7 <br /> Structure Operation Feeding/Water a <br /> ,+ l V '� J/� ,�i ,e.,, �`y --11 c� • <br /> ❑ ❑ I8. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings q .i _1 r l c+y��+1. i� J rC o✓d <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL o" L vt;,,waf.S <br /> Structure Operation Water Well <br /> 11El1. Well Construction yr • <br /> 11 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin O J i <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 /> ❑ ❑ 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 /> ❑ ❑ 17. Sewer. <br /> Structure Operation Rabies Vaccination RECEIVED BY INSP CTOR <br /> ❑ ❑ 18. Certificate on Premises n"l . <br /> EHD 40-06 6/30/2005 age of <br />