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PQUiN SAN JOAQUIN COUNTY <br /> ` " z ENVIRONMENTAL HEALTH DEPARTMENT <br /> LO <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 /> p.F p R <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCHDB kk INSPECT N ATE Ili a <br /> Structure Operation Water Well r <br /> ❑ ❑ 1. Well Construction PREMISE ADDRE R NSP TION D TE <br /> P <br /> ❑ ❑ 2. Cross-Connection / <br /> Structure Operation Manure Management OWNEIRIOPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE UPROGRAM ELEIIENT RECO-RD ID <br /> 8 <br /> ❑ ❑ 5. Lagooning r <br /> ❑ ❑ 6. Composting The items beloO re resent code violations and must he corrected: <br /> Structure Operation Bird Disposal <br /> ® L <br /> 1:1 El 7. Burying with 2"of Cover y <br /> ❑ ❑ 8. Approved Concrete Tank it <br /> ❑ ❑ 9. Removal from Premises C <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> 11 11 13. Pupae <br /> ❑ ❑ 14. Adult <br /> El ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> 11 ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> 0El22. Walls/Ceilin si4t6it. &,A 6ma t��k�a4g=A <br /> ❑ 1 ❑ 1 23. CleaninE Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction <br /> ❑ 112. 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 /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ 0 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 /> 11 El 16. Septic System <br /> ❑ 0 17. Sewer <br /> Structure operation Rabies Vaccination =EB IN CTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of_ <br />