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"I" • SAN JOAQUIN COUNTY <br />ooG <br />Mr< ENVIRONMENTAL HEALTH DEPARTME <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />c �P <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 6/30/2005 d Page AL of <br />g z4 36 <br />POULTRY RANCH <br />DBA <br />f�11 QJ <br />/ <br />(� �L-� <br />INSP CTION DATE <br />9 ' 2 - �� <br />Structure Operation Water Well <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS3 <br />1 <br />rci <br />REINSPECTION DATE <br />Z <br />11 El 2. Cross -Connection <br />Structure <br />Operation <br />Manure Management <br />OWNER/OPERATOR <br />r7^ <br />PHONE <br />J <br />t7 ? b%� <br />❑ ❑ 3. Spreading and Disking <br />❑ <br />❑ <br />4. Concrete Tanks <br />INS ECT N TYPE <br />1,+7'.[ A0611« I <br />PROGRAM ELEMENT <br />`i s- I <br />RECORD ID <br />1/� <br />❑ ❑ 5. Lagooning <br />❑ <br />❑ <br />6. Composting <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Disposal <br />❑ ❑ 7. Burying with 2" of Cover <br />Cl <br />❑ <br />8. Approved Concrete Tank <br />/ <br />Ci(n ` ttiln <br />❑ ❑ 9. Removal from Premises <br />Structure <br />Operation <br />Vector Control <br />❑ Q 10. Domestic Fl <br />❑ <br />❑ <br />11. Fannia Fly <br />f <br />..1 <br />❑ tW, 12. Larvae <br />❑ <br />❑ <br />13. Pupae <br />IM h0, <br />u <br />❑ ❑ 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />t <br />LL <br />hT>"� <br />r <br />❑ ❑ 16. Moderate Po ulation <br />❑ <br />❑ <br />17. Heavy Population <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Troughs <br />❑ ❑ 19. Cups or Bowls <br />❑ <br />❑ <br />20. Food Storage <br />2o�bb; <br />Structure Operation Houses <br />❑ <br />❑ <br />2l. Floors <br />Q n¢YV <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleaning Frequency <br />Lid <br />KENNEL <br />Structure <br />Operation <br />Water Well <br />❑ ❑ I. Well Construction <br />❑ <br />❑ <br />2. Cross Connection <br />�% 1. <br />ADQ <br />12(� <br />Structure Operation Floorsoat'r <br />❑ <br />❑ <br />3. Properly G ded to <br />/ <br />❑ 4. Drain <br />❑ <br />5. Smoo Cleanable <br />❑ ❑ 6. Cov' <br />❑ <br />❑ <br />7. Cl anin Fre uenc <br />Structure Operation N W s <br />❑ <br />❑ <br />Smooth/Cleanable <br />�"(� <br />h��.h�+G- r 471 <br />t <br />❑ ❑ A Cleaning Frequency <br />Structure <br />Operation <br />C eS <br />4�ar\.^e- <br />❑ ❑ 10. ondition <br />❑ <br />11. Autation <br />�- <br />D <br />T r.- 1. <br />Structure Ope tion <br />❑ <br />❑ ❑ in <br />Structure <br />Operation <br />VDissal <br />l❑ <br />(✓` <br />�Z- d V <br />"2-3"0G. <br />❑ m Premises <br />❑ <br />❑ <br />Struct a Operation Sewage Disposal <br />❑ <br />1 16. Septic System <br />❑ 17. Sewer <br />St tore <br />Operation <br />Rabies Vaccination <br />CEIV <br />INSPECT <br />❑ ❑ 18. Certificate on Premises <br />EHD 40-06 6/30/2005 d Page AL of <br />g z4 36 <br />