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SAN JOA IN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEP <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> °ati R :c <br /> Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well v0 L. <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Stru tore Operation Manure Management OWNER/OPERATOR P ONE q <br /> El3. Spreadi g and Disking / <br /> ❑ ❑ 4. Concr e Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID DO <br /> ❑ ❑ 5. Lagoq6g +ate <br /> ❑ ❑ 6. Co osting The items below represent code violations and must be corrected: <br /> Structure eration Bird#isposal <br /> ❑ 7. B ing with 2"of Cover <br /> ❑ IN 8. ipproved Concrete Tank <br /> ❑ IA 9./Removal from Premises 1 f o <br /> Structure Operatio Victor Control <br /> ❑ ❑ 0. Domestic FI I <br /> ❑ 011. Fannia Fl [ <br /> 1:1 E312. Larvae <br /> El . Pupae <br /> El1 k Adult <br /> El 15. i ht Population <br /> o <br /> 1316. Noderate Population 15 <br /> ❑ 17. F[Vvy Population <br /> Structure Aeration Feedin Water S <br /> ❑ ❑ 18. Watk Troughs <br /> ❑ ❑ 19. Cups 4 Bowls <br /> ❑ 20. Food Sthrage <br /> Structur Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> El ❑ 1. Well Construction <br /> 11 ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to / <br /> ❑ ❑ 4. Drain I it va <br /> ❑ El 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 7. Cleaning Frequency <br /> e <br /> Structure Operation Walls 1, y <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages 1 <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ El 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> El ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVE Y INSPECT <br /> 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 1 Page Of <br />