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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <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 /> FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE -y <br /> Structure Operation Water Well / /h <br /> ❑ ❑ 1. Well Constru tion PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Conn tion A <br /> Structure Operation Manure Ma gement OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreadi and Disking 1- , ® T <br /> 4. Concr e Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. La oning <br /> ❑ 6. -posting The items below re resent code violations and must be corrected: <br /> Strutt re Operation B' d Disposal <br /> [I ❑ . BuryinE with 2"of Cover <br /> ❑ El8. A an <br /> roved Concrete Tk <br /> ❑ 139. Removal from Premises <br /> Structure era on Vector Control <br /> ❑ 10. Domestic FI Ce-o-, <br /> ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae <br /> ❑ 0 13. Pupae \ <br /> El 11 14. Adult Z-) <br /> ❑ 0 5. Light Population <br /> v <br /> ❑ 1 Moderate Population <br /> 1A Heavy Population <br /> S1--e Operation Fee ing/Water <br /> ❑ El18. ater Troughs <br /> 01 ❑ 19. C ps or Bowls 730 <br /> D Kr • <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ 11 21. Floors <br /> /r <br /> ❑ r 22. Walls/Ceilings s l l,- <br /> ❑ ❑ 23. Cleaminj Fre uenc <br /> KENNEL 'S <br /> Structure Operation Water Well <br /> ❑ 1. Well Construction <br /> 11 El 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ El 4. Drain is <br /> ❑ ❑ 5. SmootlMeanable <br /> ❑ ❑ 6. Covin <br /> 11 ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Stora e <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 0 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECE ED BY ® INSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of 1 <br />