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oP°U.1" c SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTME T <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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well Y^ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPE ION DATLE <br /> ❑ ❑ 2. Cross-Connection C <br /> Structure Operation Manure Management OWNER/ PERATOR PONE <br /> 11 ❑ 3. Spreading and Disking <br /> ❑ 0 4. Concrete Tanks INSPECTION TYPE /� TPROGRAM ELEMENT RECORD ID <br /> El C] 5. Lagooning Y 1L�--,- C& <br /> ❑ ❑ 0 40oci L*4 <br /> 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ El 7. BuEying with 2"of Cover <br /> ❑ 0 8. Approved Concrete Tank j <br /> ❑ ❑ 9. Removal from Premises 1 P <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl o'ti i <br /> ❑ ❑ 11. Fannia Fly lei r <br /> ❑ ❑ 12. Larvae �. <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> s <br /> Structure Operation Feeding/Water l- r <br /> ❑ 1118. Water Trou hs <br /> ❑ 19. Cups or Bowls <br /> ❑ 0 20. Food Storage <br /> Structure Operation Houses - ell <br /> ❑ El 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> ructure Operation Water Well / 4 <br /> NO mEl1. Well Construction 1��1 to [ 9 l <br /> ❑ 2. Cross Connecti <br /> Struts a Operation Floors <br /> E] 3. Properly Gra ed to <br /> ❑ 4. Drain <br /> ❑ 115. Smooth/ eanable t <br /> ❑ ❑ 6. Covin <br /> ❑ V 7. Cleaniri Frequency <br /> Structure Ope tion Walls <br /> ❑ 8. Smo h/Cleanable <br /> ❑ ❑ 9. C14ing Frequency <br /> Structure Operation Cage <br /> ❑ 0. londition <br /> ❑ ❑ 1 Sanitation <br /> Structure Operation F <br /> 1:1 El 2. ora e <br /> ❑ El f13. In t/Vermin <br /> Structure Operation/ Animal isposal <br /> ❑ ❑ 14. Remo 1 from Premises <br /> ❑ ❑ 15. Other <br /> Structure Opegilion Sewage Disp al <br /> ❑ P 16. Septic S s m <br /> ❑ ❑ 17. Sewer <br /> Structure Aeration Rabies Vaccinate CEIVE Y INS TO <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40 6 6/30/2005 Page 4-of <br />