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SAN JOAQUIN COUNTY <br /> {s r oG ENVIRONMENTAL HEALTH DEPARTMENT <br /> N„ v< <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 /> CC �P <br /> gc�e±oRe� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> NO <br /> Operation Water Well s <br /> ❑ 1. Well Construction PREMISE DRESS REINSPECTION DATE <br /> 2. Cross-Connection rOperation Manure Management OWNER/OPERATOR PHONE <br /> 3. Spreading and Disking 1 � ^`, 1❑ 4. Concrete Tanks INSPECTIO TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning <br /> ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Opera'on Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ 118. Approved Concrete Tank <br /> El El \9. Removal from Premises t I 1 s <br /> Structure Operation vector Control <br /> ❑ ❑ 1 . Domestic Fl a� <br /> ❑ ❑ 1 I. Fannia FI <br /> 1 P P <br /> 11F❑ 12. arvae <br /> ❑ ❑ 13. ae <br /> ❑ ❑ 14. Ad It <br /> ❑ ❑ 15. Li h Po ulation <br /> ❑ El 16. Mode to Po ulationf w. 11 <br /> El ❑ 17. Heavy ulation <br /> Structure Operation Feeding/Wa r <br /> ❑ ❑ 18. Water Tro hs <br /> ❑ ❑ 19. Cups or BAs 3 �, <br /> ❑ 0 20. Food Storage), <br /> Structure Operation I Houses �„ 4.1 S <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings /- <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well / <br /> ❑ ❑ 1. Well Construction 5 4- <br /> ❑ 02. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> s <br /> ❑ ❑ 6. Covin ) r <br /> ❑ 7. Cleaning Frequency <br /> Structure Operation Walls tks <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ 0 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Stora e <br /> ❑ ❑ 13. InsectiVermin <br /> Structure Operation Animal Disposal <br /> ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies VaccinationENE INSPEC <br /> El ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of_ <br />