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SAN JOAQUIN COUNTY Amdr <br /> 4 EN IRONMENTAL HEALTH DEPARTMEl , <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 /> c'• _ vP <br /> R{rFoR� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DB!%,_ NDAT <br /> r <br /> Structure Operation Water Well `� <br /> ❑ 1. Well Construction PREMISE ADDRESS REINS ECTIO ATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/ PERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking t 'N <br /> ❑ ❑ 4. Concrete Tanks INSPECTIOP TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning { j11ti <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 I t� kil4 /J!�KAP <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ El j 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ 0 12. Larvae <br /> ❑ El 13. Pupae <br /> ❑ ❑ 14. Adult i <br /> ❑ El 15. Light Population lei <br /> A <br /> ❑ El16. Moderate Population <br /> ❑ D 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ 0 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls Q°1 <br /> ❑ El 20. Food Storage I NJ4 <br /> t <br /> Structure Operation Houses r <br /> ❑ 0 21. Floors <br /> 13 22. Walls/Ceilings / 1r i$ <br /> ❑ ❑ 23. Cleanin Fre uenc / <br /> KENNEL l I <br /> Structure Operation Water Well /A-&-1. Well Construction l <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors (,2,;) <br /> ❑ ❑ 3. Properly Gr ed to <br /> 4. Drain , k\Ir <br /> El ❑ 5. Smooth/ eanable <br /> ❑ 6. Covin <br /> ❑ 7. Clean Frequency <br /> Structure Operati Walla K1"A 16 -177 v <br /> Awly <br /> ❑ ❑ 8. Smo th/Cleanable � f <br /> ❑ ❑ 9. Cie nin Fre uenc i� ^TJ <br /> Structure Operation age <br /> l <br /> ❑ 1 ondition Ll <br /> ❑ ❑ 11. anitation t <br /> Structure Operation F d t/� +1 l <br /> ❑ ❑ . SAage <br /> e <br /> ❑ 11 3. Ins ettnin / <br /> Structure Operation Animal D pOsal F <br /> ❑ ❑ A 14. Removh from Premises I <br /> ❑ ❑ 15. Other k ef, <br /> t t <br /> Structure operallo Sewage Dispo l <br /> 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure opera on Rabies Vaccination RECEIVED By IN; <br /> ❑ ❑ 18. Certificate on Premises I t <br /> EHD 40-06 6/30/2005 Page of <br /> ;� 1 <br />