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®PO u iN SAN JOAQUIN COUNTY -- <br /> EN RONMENTAL HEALTH DEPARTM l' <br /> Y. 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 /> �F OR <br /> VECTOR CONTROL <br /> ONTRL INSPEnTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection -70'q o. 4- <br /> Structure Operation Manure Management O NERIOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking 1100-4100 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 'C,®'� 4-014-2, 1 /Z m <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 /> ❑ 11 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises s t>Cl >-. t i <br /> Structure Operation Vector Control < <br /> ❑ ❑ 10. Domestic Fly u ii 4;'ilih <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> 11 ❑ 13. Pupae <br /> ❑ E3 14. Adult <br /> ❑ El 15. Light Population <br /> ❑ ❑ 16. Moderate Population ✓k <br /> ❑ ❑ 17. Heavy Population <br /> s <br /> Structure Operation Feeding/Water �'"' y- , Csao, ? �..� <br /> ❑ 18. Water Troughs / j <br /> 1119. Cups or Bowls n1ex p 1 i . <br /> ❑ 0 20. Food Storage <br /> Structure Operation Houses i/\ <br /> El 0 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings '<-Odb <br /> ❑ El 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> F <br /> ❑ El 1. Well Construction t«s+n <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floorsae- <br /> ❑ 3. Properly Graded to <br /> ❑ 0 4. Drain �t <br /> ro 4� <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> El 0 g. Smooth/Cleanable <br /> ❑ El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 11 10. Condition <br /> ❑ 11 11. Sanitation <br /> Structure Operation Food <br /> El El 12. Storage <br /> El 0 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 0 16. Septic System <br /> 11 0 17. Sewer <br /> Structure Operation Rabies VaccinationCEIVED BY INSPECTOR <br /> J <br /> 11 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of_ <br />