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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> qCt <br /> -"60 <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well h n1 <br /> ❑ ❑ 1. Well Construction PREMISE❑ ADDRESS <br /> REINSPECTION DATE <br /> 4❑ 2. Cross-Connection -10 r <br /> Structure Operation Manure Management OWNERI ERA PHONE <br /> [I ❑ 3. Spreading and Disking ��v-0>^..� `T®-2-45-7% <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning Me)qo®c> <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal a <br /> ❑ ❑ 7. Burying with 2"of Cover411 w ^ �'�-- <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises >`� <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia Fl t <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae , � p <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 1 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> / t / <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure operation Houses . !W, e4AAi `/C.- <br /> 0 <br /> ❑ ❑ 21. Floors J <br /> ❑ ❑ 22. Walls/Ceilings s czn w / ??!�e✓vtILI 2,116 O 6 <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well , r <br /> ❑ ❑ 1. Well Construction 1M®1%fit Cs�11P+�CX Yv <br /> ❑ ❑ 2. Cross Connection , <br /> Structure Operation Floors Ht T`- <br /> ❑ ❑ 3. Properly Graded to t <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable t <br /> ❑ ❑ 6. Covin t AA0 rvx/M ® X j <br /> ❑ ❑ 7. Cleaning Frequency F( <br /> Structure Operation Wails ^ t,-�-4!eE orn 4/ <br /> ❑ ❑ 8. Smooth/Cleanable t i <br /> t � <br /> ❑ ❑ 9. Cleaning Frequency w eve,^ f <br /> Structure Operation Cages {{�� / <br /> ❑ ❑ 10. Condition W 1�( ry t.�.C� 12 r- -I'1 <br /> ❑ ❑ 11. Sanitation L <br /> Structure Operation Food (.�^ � �-" <br /> ❑ 1 ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin � ,l r <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 REC BY INSPE <br /> ❑ ❑ T 18. Certificate on Premises "e <br /> EHD 40-06 6/30/2005 Page Of <br />