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o U' <br /> cap , SAN JOAQUIN COUNTY <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /> FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA K!5, <br /> c INSPECT NjD�ATE <br /> Structure Operation Water Well --lv ��' D <br /> ❑ ❑ L Well Construction PREMISE ADDRESS REI SPECTIO ATE <br /> ❑ ❑ 2. Cross-Connection I O V%P- <br /> Structure Operation Manure Management OWNE PHONE /�/� <br /> 0] C] 3. Spreading and Disking 93 -616112, <br /> 2, <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning / 14 d7'0 Y.2, A D` DID <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 <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI 1 <br /> ❑ ❑ 12. Larvae - VW <br /> ❑ ❑ 13. Pupae ^� <br /> ❑ [114. Adult J MID `v! <br /> ❑ ❑ 15. Light Population <br /> El El16. Moderate Po ulation L fl00 <br /> ❑ ❑ 17. Heavy Population _ <br /> 000 b <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs \ <br /> ❑ ❑ 19. Cups or Bowls vl$2_ QX' W Orr <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Wails/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction \0 V4 'yyo G.S <br /> ❑ ❑ 2. Cross Connection _ <br /> Structure Operation Floors ,�,\ S <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable � ^� <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages (Q� _ �` (� <br /> El El 10. Condition Off- _�-�7 V V UL �\t GSA' AAt 1/t71 <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage _ <br /> ClN40❑ 13. Insect/Vermin !1 i <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation 1 Sewage Disposal O <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY IN O <br /> ❑ ❑ 18. Certificate on Premises O <br /> EHD 40-06 6/30/2005 Page Of <br />