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oP°ui" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> c �P <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA � INSPECTION DATE <br /> Structure Operation Water Well 6-21-LZ <br /> ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection y- <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking % &&.2 z2ol- <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items b low re resent code violations and must be corrected: <br /> Structure Operation Bird Disposal VF <br /> ❑ ❑ 7. Burying with 2'of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fly Kino <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae bl $ <br /> ❑_ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 1116. Moderate Population <br /> 11 El17. Heavy Po ulation <br /> Structure Operation Feeding/Water -- <br /> ❑ ❑ 18. Water Troughs L <br /> 11 El 19. Cups or Bowls 1- b <br /> AA C- <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> K E N N E L <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction 01, -S MC&J CA,t <br /> ❑ ❑ 2. Cross Connection pp <br /> Structure Operation Floorsalte'- . <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequencyy <br /> Structure Operation Walls L' <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation I Cages 1 <br /> ❑ ❑ 10. Condition 1' L+ 1' <br /> ❑ ❑ 11. Sanitation � 61-J) XrY7 S <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. InsectfVermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer. <br /> Structure operation Rabies Vaccination RECEIVED qY INSPE O <br /> ❑ ❑ 18. Certificate on Premises �, b <br /> EHD 40-06 6/30/2005 Page_Of- <br />