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PO U i y S SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />�. 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br />cgC1F.oRa�c <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 t -./ `." j) Ctl Pagel -of -;Z- <br />POULTRY RANCH <br />DBA 7 <br />J<r% .1.. <br />INSPECTION DATEy <br />G,. <br />Structure Operation Water Well <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />l k <br />REINSPECTION DATE <br />11 El2. Cross -Connection <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPERATOR <br />l - <br />PItAEI�_ G�i - y <br />iCl t - L -SKI <br />❑ ❑ 3. Spreading and Disking <br />❑ <br />❑ <br />4. Concrete Tanks <br />INSPECTION TYPE <br />t,lC��t� <br />PROGRAM ELEMENT <br />L�� 5 <br />RECORD ID <br />❑ ❑ 5. Lagooning <br />❑ <br />❑ <br />6. Composting <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disposal <br />�� 1 <br />❑ ❑ 7. Burying with 2" of Cover <br />❑ <br />❑ <br />8. Approved Concrete Tank <br />❑ ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />UC <br />ti ✓ S <br />❑ ❑ 10. Domestic FI <br />❑ <br />❑ <br />11. Fannia FI <br />J t'" <br />❑ ❑ 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />S <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />❑ ❑ 16. Moderate Population <br />❑ <br />17. Heavy Population <br />t <br />c,c .l VL ,yt Z <br />z. <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Troughs <br />❑ ❑ 19. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />,n <br />V I <br />\ <br />L <br />Operation <br />Structure Houses <br />Cl <br />❑ <br />21. Floors <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequencyl <br />ayL h �e-✓ <br />lw nrG <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />\ <br />+ <br />!p ✓�- ��' <br />❑ ❑ 1. Well Construction <br />❑ <br />❑ <br />2. Cross Connection <br />1/l 2 <br />f� <br />Structure Operation Floors <br />❑ <br />❑ <br />3. Properly Graded to <br />e <br />❑ ❑ 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />K <br />7 <br />\ / <br />❑ ❑ 6. Covin <br />❑ <br />❑ <br />7. CleaningFre uenc <br />Structure Operation Walls <br />❑ <br />❑ <br />8. Smooth/Cleanable <br />: i \ <br />_ L <br />f /) i6 <br />❑ ❑ 9. Cleaning Frequency <br />Structure <br />Operation <br />Cages <br />❑ ❑ 10. Condition <br />❑ <br />❑ <br />11. Sanitation <br />` r <br />VT (f <br />Strueture Operation Food <br />❑ <br />❑ <br />12. Storage <br />fi�' C)til' j iYl <br />y <br />7 ✓$�� <br />❑ ❑ 13. InsectfVermin <br />Structure <br />Operation <br />Animal Disposal <br />❑ ❑ 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Adt/ re <br />l <br />T� <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />16. Se tic S stem <br />j� <br />1 ►Z A PLY 1) ' <br />❑ 1:117. Sewer <br />Structure <br />Operation <br />Rabies Vaccination <br />RECEI D BY <br />UJ� <br />INSP T R <br />❑ ❑ 1 18. Certificate on Premises <br />EHD 40-06 6/30/2005 t -./ `." j) Ctl Pagel -of -;Z- <br />