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OPO U i N c • SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM T <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 /> FOR <br /> OO A "q;© VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECN <br /> DAT <br /> Structure Operation Water Well t <br /> 11 <br /> ❑ 1. Well Construction PREMISE ADDRESS �j� REINSPECTION'DATE <br /> ( Owy <br /> ❑ ❑ 2. Cross-Connection '7 /7 s t ,"y�` q� �C/ k" � <br /> Structure Operation Manure Management OWNER/OPERATOR � PHONE �j <br /> ❑ ❑ 3. Spreading and Disking ad Q r Y(,X � -"' O 7 1-5" <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE () PROG,RAAI 45-q <br /> EMENT CORDID <br /> [I C35. La ooning g ,/K) fVL �I,i'1C[RX 1 f/P-#-Q Ll 000&7 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure ope on Bird Disposal <br /> ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank / f1 <br /> ❑ ❑ 9. Removal from Premises / • Food in 0-r ol Cowf ,I uers <br /> Structure Operation NPctor Control t` _J r ^Q' on shdve Q� CIioo� <br /> El El10\. D Domestic Fl F'✓\ (� 1�� J Floor. <br /> ❑ ❑ 11. Nnnia FI <br /> ❑ ❑ 12. La aeEl C1 13. Plupa\ <br /> �J I �I <br /> ❑ ❑ 14. dult • 1` ✓�1 �S oLv d �I o o r J �iJ e o-vv �, .�1 I rx <br /> El ❑ 15. Light Po lation <br /> ❑ ❑ 16. Moderate hPulation od / h V <br /> ❑ ❑ 17. Heavy Po ul ion <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. WaterTroughs <br /> ❑ ❑ 19. Cupsor owls • MOr 'J klx�1d0 vvl St it <br /> ❑ ❑ 20. Food Storage / �j . t <br /> Structure Operation Houses vefe�1 lr/1 pi- Or .�C�'YlC_� •v`"�" <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ K E N. Cleaning Frequency r , �e S o y-e�d� are- <br /> Structure Operation Water Well �/ • -� �-e� / ^ - rrerf' <br /> ❑ ❑ 1. Well Construction l//{�- /V,I'�y <br /> [Ell ❑ 2. Cross Connection <br /> Structur ration Floors <br /> [Ell ❑ 3. Properly Graded toyt <br /> ❑ El 4. Drain V T. ��t y-�C)..MA_a J of <br /> ❑ ❑ 5. Smooth/Cleanable -�-{ ( - <br /> ❑ ❑ 6. Coving F I <br /> ❑ ❑ 7. CleaningFre uenc <br /> Structure rpperation Walls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ It. Sanitation n �' o�f T © e�.Jn/ <br /> Structure Operation Food lJ f (•(�n n C/� a <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 /> 110 ❑ 16. Septic S stemn <br /> ❑ El 17. Sewer V rt*u. a�C It <br /> Structure Operation Rabies Vaccination ED INSPECTOR <br /> ❑ 4Z❑ 18. Certificate on Premis <br /> EHD 40-06 6/30/2005 Page 4-Of <br />