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P°"l" SAN JOAQUIN COUNTY <br /> AIRONMENTAL HEALTH DEPART T <br /> 0- <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 /> ��FORa <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well C <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection . p <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking CkwW ew r 5 ' ZI -2 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> 1:1 ❑ 5. Lagooning �(;�, � '//-tCI 6 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises 1 N � <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae C444,Oh <br /> ❑ ❑ 13. Pupae <br /> . C r� <br /> ❑ ❑ 14. Adult , <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water t <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls ^ _Y vVt '✓" <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequencyt j <br /> K E N N E L - <br /> Structure Operation Water Well +^ <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection ` t <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain - L7 <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls - r <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency C "`t <br /> Structure Operation Cages �. <br /> ❑ ❑ 10. Condition 1 � <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food \ <br /> ❑ ❑ 12. Storage {{ <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises Ar, t" YYIC l t <br /> ❑ ❑ 15. OtherT l 4 t _ j <br /> Structure Operation Sewage Disposal t /- ✓ he /q°t" -1✓ <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer UIl MAD 2A 441:r, d- C4- <br /> Structure operation Rabies Vaccination RECEt77 (/ INSP C R el <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_L of <br />