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SAN JOAQUIN COUNTY <br /> P •• <br /> N: < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �%FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation _Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. cross-connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 1 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ [:j 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 / j 1► Om <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises 1 Cr - 1 R <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic -FI r 1�� , C d 1 <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae 11,3d .2 ,r) , <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population ll U[ l ` T Tc 1 C•, V ", /� <br /> ❑ 13 17. Heavy Population <br /> Structure Operation Feeding/Water - I - - <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ ❑ 1 19. Cups or Bowls <br /> ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> El 0 2. Cross Connection <br /> Structure Operation Floors <br /> El 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ 13. InsecWermin <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 BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />