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SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Wi <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 /> �!FpR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAINSSPECTIO DATE <br /> Structure Operation Water Well t <br /> ❑ ❑ 1. Well Construction PREMISSEE ADDRESS REIN PE ION DATE <br /> ❑ ❑ 2. Cross-Connection V ®° <br /> Structure Operation Manure Management OWNS OPERATOR / PHONNE�n ry <br /> 1:1 ❑ 3. Spreading and Disking / „5 !( L73 -,C> 1" <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPO PROGRAM ELEMENT ECORD ID <br /> ❑ ❑ 5. Lagooning pj" S-qL/00054 <br /> ❑ El 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> El El 7. Burying with 2"of Cover / ® �/ .s C /� <br /> s / `at <br /> ❑ ❑ 8. Approved Concrete Tank A <br /> ❑ ❑ 9. Removal from Premises ' r a + O 4 e!`- I^ e/ <br /> Structure Operation Vector Control Or <br /> ❑ 10. Domestic Fly 55®7 Awe-soeA Ar- /- e^ d , ZAI- <br /> ❑ ❑ it. Fannia Fl ` <br /> ❑ 0 12. Larvae G�i (,t /jZiV$� (JPI°I✓ G At /W( <br /> ❑ 0 13. Pupae <br /> ❑ ❑ 14. Adult /e e• orf✓!.'° <br /> 11 ❑ 15. Light Population �^ / <br /> El 11 16. Moderate Population �' �. /- /ems OT <br /> ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water &0111"11 � rA k <br /> ❑ 18. Water Troughs <br /> t I r❑ ❑ 19. Cups or Bowls e�1 / <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses 061-6 tilgt& 12e, <br /> ❑ ❑ 21. Floors <br /> ❑ 22. Walls/Ceilin s dik <br /> ❑ 23. Cleanin Fre uenc // / <br /> KENNEL �GO� 7"0 ( /S $ <br /> Structure Operation Water Well <br /> t <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors COYI V/e/?/esl. Wu.>4i 194 le <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 4. Drain /;S s *-<4'l/°ft*cS S 4VAId ®rG <br /> ❑ ❑ 5. Smooth/Cleanable / <br /> ❑ ❑ 6. Covin W Pl IL!'ta IT. <br /> ❑ 11 7. Cleaning Frequency <br /> Structure Operation Walls t e <br /> ❑ ❑ 8. Smooth/Cleanable `G <br /> El El 9. CleaningFrequency or S .P' <br /> Mne <br /> Structure Operation Cages � ,f <br /> El 10. Condition T`/ .0" Q d a- <br /> ❑ ❑ 11. Sanitation /� <br /> Structure Operation Food S f (I� <br /> R S <br /> ❑ ❑ 12. Storage <br /> ❑ 0 13. Insect/Vermin a <br /> Structure Operation Animal Disposal / <br /> 1114. Removal from Premises (Z K 6 Lf be e-014 /�J AT <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal mesA <br /> ❑ ❑ 16. Se tic System <br /> ❑ ❑ 1 17. Sewer <br /> Structure Operation Rabies Vaccination :M1 <br /> El El18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of �-- <br />