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SAN JOAQUIN COUNTY <br /> 4 ? ENVIRONMENTAL HEALTH DEPARTMENT <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 /> Qq{`F.OR�P <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA In INSPECTION DATE <br /> Structure Operation Water Well 'dDt t 8 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS I REINSPECTI N DATE <br /> ❑ ❑ 2. Cross-Connection 1 t ZLQ J 1 <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE ®g <br /> ID 3. Spreading and Disking 4'D J ® ®`C <br /> ❑ ❑ 4. Concrete Tanks IrN'')SPECTION TYPE! PROGRAM ELEMENT RECORD ID <br /> ❑ El5. Lagooning KQi 1Fjs <br /> El [16. Composting The items b low re resent code violations and must be corrected: <br /> Structure Operation Bird Disposal s <br /> El El 7. Burying with 2"of Cover 11� e'SY 1 '-G. �"� �) .�-1-• <br /> ❑ ❑ 8. Ap2roved Concrete Tank t Q <br /> El 9. Removal from Premises P .e- t a P 5, \ G <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> ❑ ❑ 11. Fannia Fl ll ' <br /> El ❑ 12. Larvae 1 "'l 5 t 7-z- <br /> ❑ 1 0 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Po ulation <br /> ❑ ❑ 16. Moderate Population 1 f Je 4ti I <br /> ❑ El 17. Heavy Population ( -� <br /> Structure Operation Feeding/Water k 64 D t t!i CC."A- X• <br /> ❑ 1 ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food StoraLe qq _ <br /> Structure Operation Houses J i et-3 .5 A-T- We re- VAA� to 1 <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings . C- G <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction (At1J <br /> ❑ El 2. Cross Connection ® <br /> Structure Operation FIOOfS C.. t4ettvt-C. <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 /> ❑ El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. InsectlVermin <br /> Structure Operation Animal Disposal <br /> 11 ❑ 14. Removal from Premises <br /> 11 0 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ 1 ❑ 17. Sewer <br /> Structure operation Rabies Vaccination R ED BY <br /> El F-1 18. Certificate on Premises ^ <br /> EHD 40-06 6/30/2005 ILPage_of <br />