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PQ ui k SAN JOAQUIN COUNTY <br /> m. <br /> o_ � e <br /> 4 ®2 EN ONENTAL HEALTH DEPARTMER <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> egciFOR"'�P <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECTION DATE <br /> Structure Operation Water Well h `` <br /> ❑ ❑ 1. Well Co struction PREMISE ADD SS REI SPECTION DATE <br /> ❑ ❑ 2. Cross- onnection a t <br /> Structure Operation Manure anagement OWN R/OPERATOR PHONE <br /> ❑ ❑ 3. Spr ding and Disking ®' I '33�® <br /> ❑ 4. Co trete Tanks INSPECTION PE PROGRAM ELEMENT RECORD ID <br /> 5. gooning ,ysa hp\ti-' <br /> ❑ ❑ 6. omposting The items below represent code violations and must be corrected: <br /> Structure Operation B d Disposal <br /> ❑ ❑ <br /> Burying with 2"of Cover <br /> ❑ ❑ Approved Concrete Tank <br /> ❑ /9. Removal from Premises [� <br /> Structure operkionfi Vector Control <br /> ❑ 10. Domestic FI <br /> ❑ ❑ 11. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ Qn 13. Pupae ) 9 <br /> ❑ 4. Adult i <br /> ❑ ❑ 1 Light Population <br /> ❑ ❑ 16. Moderate Po ulation °e i ate,e <br /> ❑ 0 17. Xeavy Population <br /> Structure Operation Feedi Water <br /> ❑ ❑ 18. Wa r Troughs <br /> ❑ ❑ 19. Cups r Bowls <br /> [31 ❑ 20. Food S rage <br /> Structure Operation Houses <br /> ❑ Cl 21. Floors <br /> ❑ ❑ 22. Walls/Ceiling <br /> ❑ ❑ 23. Cleanin Frequent <br /> KENNEL as <br /> Structure Operation Water Well <br /> ❑ 11 1. Well Construction <br /> ❑ El 2. Cross Connection e <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to p p <br /> ❑ ❑ 4. Drain 1 / <br /> 11 El 5. Smooth/Cleanable <br /> ❑ 0 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> 11 ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> 11 0 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 1 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> 11 ❑ 14. Removal from Premises <br /> ❑ El 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vac�On, <br /> RE IV Y INSP <br /> ❑ ❑ 18. Certificses <br /> EHD 40-06 6/30/2005 Page Of/ <br />