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oPa t,i" r SAN JOAQUIN COUNTY <br /> p? ENVIRONMENTAL HEALTH DEPARTME <br /> 0 <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> x Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> yy CONTROL <br /> �i y�/-t <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> r <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection r. <br /> Structure Operation Manure Management OWNER/ .ERA PHONE �y <br /> El [13. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENTRECORD ID <br /> ❑ ❑ 5. Lagooning Ao,4- <br /> 0 ❑ 6. Composting The items below re resent code violations and must be corrected: <br /> Structure Operation Bird Disposal ® d <br /> ❑ El7. Burying with 2"of Cover <br /> 11 El 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises --h9 <br /> Structure Operation Vector Control <br /> ❑ 10. Domestic Fly 1 to l <br /> ❑ ❑ 11. Fannia FI ` <br /> ❑ n 12. Larvae <br /> ❑ El 13. Pupae <br /> ❑ ❑ 14. Adult <br /> 11 ❑ 15. Light Population <br /> 1116. Moderate Population bLP4111 6 <br /> ❑ ❑ 17. Heavy Population <br /> structure Operation Feeding/Water /t �O <br /> /14- <br /> ❑ 0 18. Water Troughs <br /> ❑ ❑ 19. Cu2s or Bowls 1 t44,,- +� <br /> ❑ El 20. Food Storage <br /> Structure Operation Houses 01 ae%4-( ►t / <br /> ❑ El 21. Floors <br /> ❑ Cl 22. Walls/Ceilin s / X11® amt <br /> ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction ���► 1Atr\ l°v <br /> ❑ ❑ 2. Cross Connection Ae <br /> a <br /> Structure Operation Floors <br /> ❑ 3. Properly Graded to ® , <br /> ❑ ❑ 4. Drain <br /> ❑ El 5. Smooth/Cleanable ? �` <br /> ❑ ❑ 6. Coving ryx/M x 6 / F.✓e� )c <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls ( e ti J <br /> ❑ ❑ 8. Smooth/Cleanable <br /> t t � <br /> ❑ ❑ 9. Cleaning Frequency + / <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition L j I It r-o 641,f 4c> r t' ` <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food / - d <br /> ❑ El 12. Storage <br /> ❑ ❑ 13. Insect/Vermin , 4inis rx'�--. <br /> Structure Operation Animal Disposal <br /> El El 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RE ED BY INSPE <br /> ❑ j ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page TOf <br />