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SAN JOAQUIN COUNTY <br /> G ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q. :_..•;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INS <br /> P TION TE <br /> Structure Operation l zm <br /> S TW <br /> ❑ ❑ 1. Well Construction PREMIS ADDRESS INSPEC ON DATE <br /> ❑ ❑ 2. Cross-Connection <br /> ecr <br /> Structure Operation Manure Mana ement OW ER(OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRA ELEMENT REWF3D 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 4" •/lJ C�T►`Z1V <br /> ❑ ❑ 8. Approved Concrete Tank <br /> 1:1 El ` �` <br /> 9. Removal from Premises j <br /> Structure Operation vector Control <br /> ❑ ❑ 10. Domestic FI • <br /> 11. Fannia FI <br /> r <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 1 14. Adult G <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Po ulation <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage A <br /> Structure Operation Houses !1Z <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL144, <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction s <br /> El 2. Cross Connection <br /> Structure Operation Floors FSC; <br /> 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain Lj OA /1 AQ <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin (� , A/ <br /> ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages L <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 1 12. Storage <br /> 13. InsecWermin � <br /> U tit <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED INSPECTOR <br /> El 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />