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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /> 9(jFOR1.1 <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA AINSPECTION DATE <br /> Structure Operation Water Well • 4 � 'N e` / <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESd PE ION DATE <br /> 11 El2. Cross-Connection /01 12-., <br /> ry- 1t <br /> Structure Operation Manure Management OWNER/OPERATOR I PHONE t, <br /> El [-13. Spreading and Disking ' ,$ d t l 1 of Gr "f 3 ®' ®-1 eq <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPEw PROGRAM <br /> CELEMENT RECORDID <br /> ❑ ❑ 5. Lagooning qq,5 / P_4 V J <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal (� <br /> ❑ El 7. Burying with 2"of Cover �� ®N V / -_41 ~Ig r 4 G C OAS-Gti:.�G.O <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control <br /> ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia Fl <br /> ❑ ❑ 12. Larvae V T 5;9-kPWb1 2 p�• <br /> ❑ ❑ 13. Pupae ® / <br /> 11 ❑ 14. Adult ldmm I ` Int ✓ be- <br /> 0 11 15. Light Population <br /> ❑ C3 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ El 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic S stem <br /> 17. Sewer <br /> Structure Operation Rabies Vaccination REC I ED Y <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page 2-.of`L <br />