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�o°'`' 1 N •�o SAN JOAQUIN COUNTY <br /> �t ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> C•. �P <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> aGt FORS <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA .�+ INSPECTION DATE <br /> Structure Operation Water Well •"s �1�G{ "'� Q f� <br /> j� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS ^ REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection �i -7 C7 / C - o <br /> Structure Operation Manure Management OWNS E ®e np PH/O,,NE��,�,,, �r <br /> ❑ ❑ 3. Spreading and Disking t �raaC.® IXC'^'-o tom. `7'�>2,- l) <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE (=&,20 VZ_adr 17„x, PROGRAM ELEMENT RECOORD II�D�� <br /> ❑ ❑ 5. Lagooning Vt? tc,{;-_4- �- PP4 '-f02;2 <br /> ❑ ❑ 6. Composting The items delow represent code violations and-m-ust be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover GBr� Fn ° i'/n .54-g- <br /> 11 <br /> '/ g - <br /> ❑ ❑ 8. Approved Concrete Tank LL�j ��'++ B <br /> 11 El 9. Removal from Premises l 6?a>tTT� �T L A��}1 eJc-t5pi Ic� 1.-,94 be. <br /> Structure Operation Vector Control n <br /> ❑ ❑ 10. Domestic Fl V¢.� <br /> ❑ ❑ 11. Fannia Fl //' t / /� <br /> 11 12. Larvae mS <br /> ❑ ❑ 13. Pupae ,, ((�� <br /> 11 14. Adult vpe )( 4ot 1 at 'T(. CAIS DSot <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population ,4124v 47�� i✓ <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> 11 ❑ 19. Cups or Bowls D �Z.7G�-� t7 N-a Ok-UA 1r (:::70 tie/'$ <br /> ❑ ❑ 20. Food Storage M)- <br /> Structure Operation Houses �"^Se/JC r 1'& I <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings G G.. <br /> ❑ ❑ 23. Cleaning Fr uenc r S <br /> KENNEL od'-75 t t� � � 8• l <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors D Q- <br /> ❑ ❑ 3. Properly Graded to <br /> t <br /> ❑ ❑ 4. Drain tel-E'r © r 2J <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin t t' 4- t <br /> ❑ ❑ 7. Cleaning Frequency / <br /> Structure Operation Walls ° ,,,��... l to lOy '(ay,�-_ <br /> U 51-1 <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency 4 -A, ° <br /> Structure Operation Cages <br /> 11 1110. Condition `3 P <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 / INSPECT <br /> ❑ ❑ 18. Certificate on Premises6t <br /> EHD 40-06 6/30/2005 Page of AL <br />