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oPQ u t" c SAN JAQUIN COUNTY <br /> a.� o <br /> a ARONMENTAL HEALTH DEPART#T <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�LiF__'oar`vc <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA !w, INSPECT] `ATE <br /> Structure Operation Water Well ►V (j J�� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESSEBN ECTIO ATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management WNE ERATO PHONE <br /> ❑ ❑ 3. Spreading and Disking a3 M40- 7 <br /> ❑ ❑ 14. Concrete Tanks INSPEC9;;� <br /> FROG IEMENT RE RyyD IID <br /> ❑ ❑ 5. Lagooning CJ <br /> ❑ ❑ 1 6. Composting The items below represent code violations an must be correct . <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover / <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> 11 El 10. Domestic Fl <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ 0 13. Pupae fie^ <br /> ❑ ❑ 14. Adult �� J <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population / <br /> Structure Operation Feeding/Water - j <br /> ❑ 11 18. Water Troughs <br /> ❑ 19. Cups or Bowls Z-- <br /> ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors (90 <br /> ❑ I ❑ 1 22. Walls/Ceilings <br /> ❑ 1 ❑ 1 23. Cleaning Frequent _ <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ V 1. Well Const i n ss <br /> 0 IN 2. Cross Co ection <br /> Structure Opera on Floors <br /> ❑ ❑ 3. ProperX Graded to _ <br /> ❑ El 4. Drai <br /> ❑ 5. S oth/Cleanable <br /> ❑ ❑ 1 6. ving a, U' <br /> ❑ ❑ 1 7.tleaning Frequency <br /> Structure Operation alls <br /> ❑ Smooth/Cleanable <br /> ❑ 0 Cleaning Frequencyr <br /> Structure Operation Ages <br /> ❑ 10. Condition <br /> ❑ ❑ 11. anitation <br /> Structure Opent' a Foo Riy <br /> ❑ 12. S rage <br /> ❑ 13. Ins t/Vermin <br /> Structure o tion Animal isposal <br /> 11 JQ 14. Removal from Premises <br /> 11 /El 15. Other <br /> Structure 4peration Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rallies Vaccination RECEIVED BY INSPEC ` <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />