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SAN JOAQUIN COUNTY <br /> o � c <br /> ENVI ONMENTAL HEALTH DEPARTMEtT <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 DB INSPECTION DATE <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REIN ECTI N DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT R CO D ID <br /> 13 ❑ 5. Lagooning I A r <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 �: e <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water Via <br /> ❑ ❑ 18. Water Trou hs <br /> ❑ 0 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage g t e <br /> Structure Operation Houses l y'" <br /> El El 21. Floors <br /> ❑ El 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleaning Frequencys <br /> KENNEL <br /> Structure Operation Water Well <br /> 11 0 1. Well Construction a <br /> ❑ ❑ 2. Cross Connection <br /> Structure peration Floors <br /> ❑ No3. Properly Gra4id to <br /> ❑ Bj 4. Drain 1 (_5) Fbt4 4,yj <br /> rs�e <br /> 5. Smooth/C anable <br /> 11 IA 6. Covin <br /> ❑ D 7. Cleanjjg Frequency <br /> Structure Operation Wails <br /> ❑ ❑ 8. S oth/Cleanable <br /> ❑ ❑ k. Q(eaningFrequency <br /> Structure Operation cues <br /> ❑ ❑ ACondition <br /> ❑ ❑ 1. nitation <br /> Structure Operation Food <br /> ❑ ❑ 12. StoVge <br /> ❑ ❑ 13. InsecVVermin <br /> Structure Opera on Animal D posal <br /> 14. Remov from Premises <br /> ❑ 15. Other <br /> Structure enation Sewage Disposal <br /> ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure operation Rabies Vaccination CEIVED INSP <br /> ❑ ❑ 18. Certificate on Premises40 <br /> EHD 40-06 6/30/2005 Page Of <br />