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" SAN JOAOUIN COUNTY <br /> 2ter, 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q- <br /> '. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> L 6i6' <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY R A N C H DBA eV INSPE ION TE <br /> Structure Operation �! <br /> El El 1. Well Construction PREMISE ADDRESS RE-[ PECTI N DATE <br /> ❑ ❑ 2. Cross-Connection 1�() 110 i <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking .201 88(0-/(Om <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE L PROGRAM ELEMENT RE/Q_0R.,D IID., <br /> 11 F] 5. Lagooning a0 t/ IA-;t4- com <br /> ❑ ❑ 6. Composting The items Blow represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover T� VAS �� <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises AMP' <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> ❑ 0 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae , <br /> ❑ ❑ 14. Adult f ItJv IG O <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. HenPopulation <br /> Structure Operation Feeding <br /> /1Nater <br /> ❑ ❑ 18. Water Troughs AA <br /> E] ❑ 19. Cups or Bowls V A <br /> El ❑ 20. Food Storage <br /> Structure Operation Houses V <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings Q <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL tA <br /> Structure Operation Water Well <br /> El El 1. <br /> 1. Well Construction <br /> ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain V <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> ❑ 7. Cleaning Frequency <br /> t ,e <br /> Structure Operation Walls h S -�'� ,p <br /> ❑ ❑ B. Smooth/Cleanable ,,�`` //� <br /> El 119. CleaningFrequency LO -vU r� <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage _ / <br /> EJ 1-113. InsectfVermin N l(_ �/Vf-&t I <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 t ED BY INs QT R <br /> ❑ ❑ 1 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of_ <br />