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SAN JOA QUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br />EHD 40-06 6/30/2005 Page -1 of I- <br />POULTRY RANCH <br />DBA <br />INSPECTION/DATE <br />Structure <br />Operation <br />Water Well <br />a- <br />0 <br />0 <br />1. Well Construction <br />PREMI§E ADDRP§S <br />REINSPECTION DATE <br />11 <br />0 <br />2. Cross -Connection <br />15�2-1 A zu. Lclwa' <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPERATOR I I <br />PHONE <br />El <br />El <br />3. Spreading and Disking <br />�m2l' 1, <br />ve-� y <br />-7Z?-36 9-Z- <br />0 <br />1 0 <br />4. Concrete Tanks <br />INSPIfCTIOWTYPEqGRAm <br />ELEMENT <br />RECORDID <br />1:1 <br />0 <br />5. Lagooning <br />rp-L-47k-e- 1 7�"44(�- <br />El <br />[1 <br />6. Composting <br />The items below represent code violations and must be rarripetptf- <br />Structure <br />Operation <br />Bird Disposal <br />E] <br />El <br />7. Burying with 2"ofCover <br />El <br />1:1 <br />8. Approved Concrete Tank <br />11 <br />1:1 <br />9. Removal from Premises <br />gcv CIA 1-6kpi,-4 6>15 lh� <br />Structure <br />Operation <br />Vector Control <br />r n n.&I pr <br />1!5 0 <br />0 <br />0 <br />10. Domestic Fly <br />El <br />El <br />11. Fannia Fllay <br />El <br />E3 <br />12. Larvae <br />11 <br />0 <br />13. Pupae <br />1:1 <br />El <br />14. Adult <br />❑ <br />15. Light Populatio <br />16. Moderate Population <br />1:1 <br />0 <br />17. Heavy Population <br />A <br />Structure <br />Operation <br />Feeding/Water <br />PC'r"d. <br />1:1 <br />El <br />18. Water Troughs <br />0 <br />E3 <br />19. Cugsor Bowls <br />11 <br />0 <br />20. Food Storage <br />04 <br />Structure <br />Operation <br />I Houses <br />Mor4- <br />I <br />1:1 <br />El <br />21. Floors <br />❑ <br />22. Walls/Ceilings <br />El <br />C3 <br />23. Cleaning FrequencX <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />11 <br />0 <br />1. Well Construction <br />1:1 <br />F-1 <br />2. Cross Connection <br />Structure <br />Operation <br />Floors <br />V- I' 1-- 1, <br />0 <br />3. Properly ded to <br />El <br />El <br />4. Drain / <br />❑1 <br />5. SmVth/Cleanable <br />6. g/ing <br />❑ <br />7.,ttleaning Frequency <br />Structure <br />OpcNtion <br />pe <br />ails <br />A,- 4290 Ci. <br />0 <br />(A 118. <br />Smooth/Cleanable <br />11 <br />0 V <br />9. Cleaning Frequency <br />Structure <br />op --A <br />OP., <br />cages <br />/\J0 <br />El <br />V] <br />10. Condition <br />11 <br />ILI <br />1. Sanitation <br />Structure <br />pe -tion <br />Nod <br />0 <br />C❑ <br />12. Stora <br />r <br />El <br />13. lusectivermin <br />Street re <br />Operation <br />AnimDisposal <br />El <br />14. Re oval from Premises <br />11 <br />15. OthA <br />s Mere <br />Operation <br />Sewage D osal <br />❑ <br />0 <br />16. Septic stem <br />❑ <br />13 <br />17. Sewer \ <br />Structure <br />Operation <br />Rabies Vaccidhtion <br />RECEIVED INSPE <br />El <br />❑ <br />18. Certificate on Premises <br />EHD 40-06 6/30/2005 Page -1 of I- <br />