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0. C, <br /> c • SAN JOAQUIN COUNTY <br /> 5tENVIRONMENTAL HEALTH DEPARTMENT <br /> �.. < <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 /> ',f(•,�.�r'�' "� VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAS INSPE TION D 7� <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Cons ction PREMISE IDDRESS REINS ECTION DATE <br /> ❑ [12. Cross-C nection <br /> Structure Operation Manure Anagement Avey <br /> ER/OPERA R PHONE <br /> 11 ❑ 3. Spr ding and Disking • alki- - A i. 'o, 389-11310 <br /> ❑ ❑ 4. C Crete Tanks NIS ECTIO TYPE PROGRAM ELEMENTF COR D{ A <br /> 11 ❑ 5. gooning f1he � rJ� W� <br /> ❑ ❑ 6/Composting The items below represent code violations and must be corrected: <br /> Structure Operation ird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank t t <br /> ❑ ❑ 9. Removal from Premises IL 00 <br /> A MgL <br /> Structure Operm n Vector Control <br /> ❑ tOpention <br /> 10. Domestic Fl <br /> ❑ 11. Fannia Flyr�- r�� D� f <br /> ❑ 12. Larvae 2- ` CJ� �reA (h. <br /> ❑ 13. Pu ae <br /> 14. Adult❑ 15. Li ht Po ulation <br /> 16. Moderate Po ulation <br /> ❑ 17. Heav Po ulationI,, nl�strucmr Feeding/Water �SY y�f reC ( s Vl�r on <br /> ❑ ❑ 18. Water Troughs c / /� t <br /> ❑ 1119. Cups or Bowls t•p v R J l•eV cc-( <br /> ❑ 20. Food Storage <br /> St lure Operation Houses r <br /> AD ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ 23. Cleaning Frequencyt� J <br /> KENNEL `b SGC (�U I� �VU►� lU�t <br /> Structure Operation Water Well <br /> ❑ ❑ 1. - struction t� � � �J an <br /> V� Vt3 Ccl of <br /> ❑ 2. Cross Connection I <br /> /Qj <br /> Structure Operation Floors 0LA' S C r a <br /> ❑ IP ❑ 3.ro Graded to <br /> ❑ 4. <br /> ❑ ❑ 5. leanable t <br /> ❑ ❑ 6 J, Wt1 iS S <br /> El ❑ 7. Frequency <br /> Structure Operation Walls <br /> ❑ Cr 118. ooth/Cleanable <br /> Cleaning Frequency El (� i•C <br /> Structure Operation CAlws <br /> l <br /> ❑ 10. Co dition <br /> ❑ ❑ ]1 nitation <br /> Structure Operation <br /> ❑ 12.korage <br /> ❑ ❑ Ixe,Insect/Vermin <br /> Structure operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Dis osal <br /> ❑ 1 . Se i ystem <br /> ❑ ❑ 17. Sewer �'�r•?x (p 7 <br /> Structure Operation Rabies VaccinationBY INSP <br /> ElCe e on Premises <br /> EHD 40-(76 6/30/2005 Page_ f <br />