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SAN JOAQUIN COUNTY <br /> ` Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> Q<%FORt� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAINSPECTION DATE <br /> r 93 -LZ- <br /> Structure <br /> Operation Water Well 5 s <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection ';;�370 �� CJ <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking �. Jln ` - f - <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning Vt o'3 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal J <br /> ❑ ❑ 7. Burying with 2"of Cover 1'C�tG <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises C <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI L iV\- f <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population i�?" .5 FCi <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water i ( ' <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage \ <br /> Structure Operation Houses J_ t <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency _ r A <br /> KENNEL S ) <br /> 42-ylel� <br /> Structure Operation Water Well <br /> 11 ❑ 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 v <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency l <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food r� <br /> ❑ ❑ 12. Storage ,/� <br /> ❑ ❑ 13. InsectfVetmin P!LvY( <br /> Structure Operation Animal Disposal ' <br /> ❑ ❑ 14. Removal from Premises Z <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECE BY /J INSP C R <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page=Of <br />