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°"'" SAN JOAQUIN COUNTY <br /> oP , c <br /> a ENVIRONMENTAL HEALTH DEPARTME <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 /> �lppR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAINSPECTION DATE <br /> Structure Operation Water Well �� d <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPEtTION DATE <br /> ❑ ❑ 2. Cross-Connection 0 <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking i (>S® 71 <br /> ❑ 4. Concrete Tanks INSPECTION TYP PROD ELEMENT RECORD ID <br /> ❑ 5. Lagooning s j,\A-5 l <br /> ❑ ❑ 6. Composting The items belo represent code violations and must be correcte <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of CoverA -� e, t <br /> 1:1 El 8. Approved Concrete Tank UA. <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FlyIN L <br /> ❑ ❑ <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 0 13. Pupae <br /> 11 ❑ 14. Adult , C? a -tL <br /> ❑ ❑ 15. Light Population ¢ <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water p L ` <br /> ❑ 11 18. Water Troughs <br /> ❑ 11 19. Cups or Bowls vy", l L` cc, d <br /> ❑ ❑ 20. Fo d Stora e <br /> Structure Operation Houses t^ t1s <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s O�A T l <br /> ❑ 1 ❑ 1 23. Cleanin Fre uenc <br /> KENNEL <br /> Structure Operation Water Well ...�„ <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection �A ( y <br /> Structure Operation Floors \,A- <br /> ❑ ❑ 3. Properly Graded to ` <br /> ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable A <br /> ❑ 0 6. Covin a\ GA- A. V, <br /> ❑ _L_gLanin_g Frequency <br /> Structure Operation Walls <br /> ❑ El 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaninp,Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ El 11. Sanitation <br /> Structure Operation Food <br /> El ❑ 12. Storage <br /> 11 ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal Jj A <br /> ❑ ❑ 16. Septic System. <br /> ❑ ❑ 17. Sewer- <br /> Structure Operation Rabies Vaccination RECEIVED BY I S ECTOR <br /> ❑ ❑ 18. Certificate on Premises ` <br /> EHD 40-06 6/30/2005 Page Of <br />