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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4.� <br /> N� :4 <br /> Tn <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;q <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE TION QATE _ <br /> Structure <br /> ater Well s S <br /> ❑ Well Construction PR SE REBS REINS ECTIO DATE <br /> ❑ e� <br /> Cross-Connection t� <br /> Structure anure Management OWNER/OPERATOR PHONE <br /> 11 Spreading and Disking F 0 - <br /> Concrete Tanks IN PECTION T E w PROGRAM ELEMENT RECORD ID <br /> ❑ [DIP Lagooning GL t <br /> 6. Composting he items bel w represent code violations and must be correct-14- <br /> Structure <br /> orrecte sStructure Operation Bird Disposal <br /> 11 D 7. Burying with 2"of Cover <br /> ❑ D 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises '\A- <br /> Structure operation Vector Control <br /> ❑ 0 10. Domestic FI ✓ dt/� <br /> ❑ ❑ 11. Fannia FI ( <br /> ❑ ❑ 12. Larvae \-o 4AJ OV 4--f <br /> ❑ ❑ 13. Pupae <br /> 11 El 14. Adult t L h <br /> ❑ ❑ 1 15. Light Population @ <br /> ❑ 16. Moderate Population "^ c <br /> El ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls 6) <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fre uenc <br /> KENNEL �,,o� / r , <br /> Structure Operation Water Well <br /> 1. Well Construction G <br /> 13 0 2. Cross Connection <br /> f OL , <br /> Structure Operation Floors L � <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> 11 ❑ 8. Smooth/Cleanable <br /> ❑ 0 9. Cleaning Fre uenc <br /> Structure Operation Cages <br /> 11 ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation e A <br /> Structure Operation Food <br /> ❑ El 12. Storage <br /> ❑ ❑ 13. Insect/Vermin VD <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises V-C' re4a Ir iw <br /> l� <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVEDY a IN CTOR <br /> 11 0 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page 707 <br />