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SAN JOAQUIN COUNTY <br /> q' NVI ONMENTAL HEALTH DEPARTMETA <br /> max.. <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> •0('�F O�FZ t.I <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPEC BON DA E <br /> structureFEM] <br /> n Water Well j <br /> ❑ 1. Well Construction PREMIS DRESS ��� REI PECTI DATE <br /> ❑ 2. Cross-Connection <br /> Structuren Manure Management OWNER/OPERATOR PHONE -7 !55 <br /> ❑ 3. Spreading and Disking 1 ,5 <br /> 1:1 <br /> - <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 11 ❑ 5. Lagooning -jj �4 L+D <br /> ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ 0 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> t <br /> ❑ ❑ 9. Removal from Premises ;C-11 114-1 <br /> Structure Operation Vector Control <br /> El 10. Domestic Fl V-161-0vJ f� <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae JJ I <br /> ❑ D 14. Adult J d.ai �✓�`f <br /> 11 ❑ 15. Light Population J <br /> ❑ ❑ 16. Moderate Population ! t� <br /> 11 17. Heavy Po ulation <br /> Structure Operation Feeding/Water C,, .s 0 IC-5 <br /> C] El 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage 1 <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Simctur operation Floors <br /> ❑ ❑ 3. Properly railed to <br /> ❑ ❑ 4. Drain <br /> ❑ 5. Smo h/Cleanable <br /> ❑ 6. Co n <br /> ❑ 7. CAaning Frequency <br /> Structure Operatio W41S <br /> ❑ ❑ 8 Smooth/Cleanable <br /> El El Cleaning Fre uenc <br /> Structure Operation ages <br /> 13 El 1 Condition <br /> ❑ ❑ i 1. Sanitation <br /> Structure opera[• n Foo <br /> El 12. St a e <br /> ❑ 13. Inse t/vermin <br /> Structure peration Animal posal <br /> ff- El 14. Remov from Premises <br /> ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ El 16. Septic System. <br /> ❑ 0 17. Sewer <br /> Structure Operation Rabies Vaccination R IV INSPEt:TO <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />