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®Pca�l(y c SAN JOAQUIN COUNTY <br /> �. OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> eq�t,Fo ��e- <br /> Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE TION D TE <br /> Structure Operation Water Well L-1^ %k ,5 V <br /> ❑ ❑ 1. Well Construction PREMISE AiDDRESS REINS CTION DATE <br /> ❑ <br /> El 2. Cross-Connection �� .5 <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking ` " -33 ®-z <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning ".'� 0 o <br /> ❑ ❑ 6. Composting The items below represent code violations and must be correcte : <br /> Structure Operation Bird Disposal <br /> ❑ 0 7. Burying with Y'of Cover L4 l .� Ll ca <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation vector Control <br /> ❑ ❑ 10. Domestic Fl t <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 1 ❑ 13. Pupae <br /> ❑ 14. Adult t b <br /> ❑ ❑ 15. Li ht Po ulation <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population 1 <br /> Structure Operation Feeding/Water <br /> ❑ 1 ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls j �C <br /> ❑ El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ 0 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings L <br /> ❑ ❑ D. Cleaning Fre uenc <br /> KENNEL <br /> Structure operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 11 ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 0 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> 11 El 12. Storage <br /> ❑ 0 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> El ❑ 14. Removal from Premises <br /> ❑ 0 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ El 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure operation Rabies Vaccination RECEIVED BY I ECTOR ` <br /> ❑ ❑ 18. Certificate on Premises fa t <br /> EFID 40-06 6/30/2005 Paged of <br />