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I <br /> Pa U 1N SAN JOAQUIN COUNTY <br /> Z ? ENVIRONMENTAL HEALTH DEPARTM <br /> it <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 /> cq�ii=oR�''vP <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA �g y� I`N�S7PE TION DAoo T J� <br /> StructurerOperation <br /> Water Well Sgsr g r l`d ( �^ of <br /> ❑ ell C struction PREMISE ADDRESS 01 REINSPECTIO DATE <br /> ❑ 2. rocs-Connection f <br /> StructureManure Management OWNER/ PERATOR PPHHONE �j❑ 3. Spreading and Disking tS I a W2-987? <br /> f <br /> ❑ 4. Co anks I SPECTION TYPE PROGRAM ELEMENT PECORD ID <br /> ❑ &=❑ 5 <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 /> ❑ 1 ❑ 8. Approved Concrete Tank �� n® P llo i <br /> ❑ El 9. moval f Premises `f"d <br /> Structure Operation V2ctor Control <br /> ❑ ❑ 10, Domestic Fl <br /> ❑ ❑ 1. Fannia Flyp _/ �� <br /> ❑ ❑ 12. Larvae /, t N014 arp� ��- AJe . /�llr�d <br /> ❑ x 13. Pupae <br /> 14. Adult are, oa,5sedv� f ti l <br /> ❑ ❑ 15. Light Population I / t? a A� � ��b � <br /> ❑ ❑ 16. Moderate Population <br /> 17. Heavy Population <br /> Structure Operation Feedin Water <br /> ❑ ❑ 18. r Troughs 10 r-i <br /> ❑ ❑ 19. Cu s or Bowls ° v: <br /> ❑ ❑ 20. Food Storage <br /> Structure Op tion Houses • Sotictr r� <br /> ❑ T 21. Floors <br /> ❑ 22. Walls/Ceilings r (Z `�. ✓ d <br /> ❑ 23. Cleaning Fre uenc ® <br /> KENNEL C) a � ick- 'led V�p <br /> j <br /> Structure Operation Water Well <br /> ❑ El 1. Well Const-j--On 5ik oqd actIAA10 tor 's: a <br /> ❑ ❑ 2. Cross ConrAction <br /> Structure Operation Floors <br /> ❑ 3. Properl Graded to <br /> ❑ 0 4. Drain <br /> ❑ 5. Sm th/Cleanable <br /> ❑ ❑ 6. C in Rkopo <br /> ❑ ❑ 7. leaning Fre uenc ® t <br /> Structure Operation ally <br /> ❑ ❑ A. Smooth/Cleanable <br /> ❑ ❑ if9. Cleaning FrequencOC 9 y s <br /> Structure Operatio Cages <br /> ❑ ❑ 10. Condition <br /> ❑ Il. Sanitation �pp�� <br /> Structure Ope tion Food '0 �/ t �5�&o h <br /> ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> 11 ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ 0 17. Sewer &Sse <br /> . <br /> Structure Operation Rabies Vaccination R EIVED INSPECTOR <br /> ❑ I ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />