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SAN JOAQUIN COUNTY <br /> z �'? ENVIRONMENTAL HEALTH DEPARTMEN <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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RA NCH DBA INSPECTION DATE <br /> Structure Operation Water Well / 6-/ S- 06 <br /> ❑ ❑ 1. Well Co struction PREMISE ADDRES9 REINSPECTION DATE <br /> ❑ ❑ 2. Cross- onnection fQ 1 <br /> Structure Operation Manur Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Sp ading and Disking <br /> ❑ 4. ncrete Tanks INSPECTION TYPEf PROGRAM ELEMENT REC RD ID <br /> ❑ 5. gooning <br /> ❑ ❑ 6/Composting The items below represent code violations and must be corrected: <br /> Structure Operation ird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ 8. Approved Concrete Tank <br /> ❑ 9. Removal from Premises <br /> Structure Opera' n Vector Control <br /> ❑ 10. Domestic Fly d <br /> ❑ 11. Fannia Fl <br /> ❑ 12. Larvae <br /> 11 ❑ 3. Pupae <br /> ❑ 1 k Adult <br /> ❑ ❑ 15. i ht Population <br /> ❑ ❑ 16. crate Population i <br /> ❑ El 17. He\yy Population <br /> Struct a Operation Fe¢din at¢r <br /> ❑ 18. Water rou hs <br /> ❑ 19. Cups or owls NIC2 <br /> 1 /� <br /> ❑ 20. Food StAge <br /> St cture Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL ��F? <br /> Structure Operation Water Well <br /> ❑ ❑ I. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 0 4. Drain <br /> ❑ El 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ El7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleanin Fre uenc <br /> Structure Operation Cages <br /> El El 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 1 ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation I Rabies Vaccination RE D Y INSPEC <br /> El El 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />