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SAN JOAQUIN COUNTY <br /> G ENVIRONMENTAL HEALTH DEPARTMENT <br /> y 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> iq.•�--•..;P Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAI t/,' INSPECTIOND4T'E <br /> Structure Operation , `t\jcpt-t. V-QQ ' <br /> , j ff 'L' <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS _ RE-INSOECTION DATE <br /> ❑ ❑ 2. Cross-Connection I Q ,--4V1 ;J <br /> Structure Operation Manure Management OWNER/O ERAT-09 PHONE <br /> ❑ ❑ 3. Spreading and Disking �[ `I�/��,� L i ?07V <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El 5. Lagooning 1/4 /t 3 0 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal ,� 1 �J <br /> El El7. Bu in with 2"of Cover l '1 , iU` C t �� 1 C l C'C 1Itious <br /> ❑ ❑ 8. Approved Concrete Tank I 1 <br /> ❑ ❑ 9. Removal from Premises L Q -,K-1 i S <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11, Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <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 <br /> Structure Operation Houses <br /> ❑ ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> 1:1 Ej 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 11 ❑ 6. Covin <br /> El El 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> D El ti. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. InsectfVermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Se tic S stem <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPECTOR <br /> •-1 � �) <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page of <br />