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OP �' SAN JOA UIN COUNTY ... ...._. - <br /> 2`' � ENV IRONMENTAL HEALTH DEPARTMER <br /> Q <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 /> q�F_oRci <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well Y'i h if 1, r 010 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Manage-int OWNER/OPERATORPHONE <br /> ❑ ❑ 3. Spreading and isking C� a t1 �t!r -- <br /> ❑ ❑ 4. Concrete Tans INSPECTION <br /> LLTYPE PRO RAM ELEMENT RECORD ID <br /> Cl [15. Lagooning �'T`� <br /> ❑ ❑ 6. CompostirA The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispolfil <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> ❑ 8. A r ed Concrete Tank <br /> ❑ 9. Re val from Premises a✓` ' <br /> Aex <br /> Structure Operati Vecto Control <br /> ❑ 10. homestic Fl <br /> ❑ El 11 Fannia FI <br /> V. Larvae r um,- <br /> 11 Pupae <br /> ❑ ❑ 14. dult r <br /> ❑ 15. hight Population <br /> ❑ 16. M erate Population <br /> ❑ 17. Hea Population j <br /> Structure Ope tion Feeding/ ter <br /> ❑ 18. Water T up-hs <br /> ❑ ❑ 19. Cups or B Is r. <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ 23. Cleaning Fre uenc <br /> KENNEL lot i^(ef <br /> Structure Operation Water Well a <br /> ❑ El 1. Well Construction (� <br /> ❑ El2. Cross Connection <br /> Structure Operation Floors <br /> kc- <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> El ❑ 8. Smooth/Cleanable y <br /> 11 El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation r <br /> Structure Operation Food 4n C- <br /> 11 11 12. Storage t <br /> ❑ ❑ 13. Insect/Vermin f <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other r <br /> Structure Operation Sewage Disposal t <br /> ❑ 0 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination R IT B INSP OR <br /> ❑ 0 18. Certificate on Premises LLty--A-11 I <br /> EHD 40-06 6/30/2005 Page of <br />