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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMqNT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> CZ. P <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAy INSPECTION DATE <br /> Structure Operation Water Well < e r ////0/// <br /> ❑ ❑ 1. Well Construction PRE SE ADDRESS REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection /// 9 <br /> Structure Operation Manure Manage me OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and string �— IF)_33 y-/.31e4' <br /> ❑ ❑ 4. Concrete Tan INSPECTMN TYPE PROGRAM ELSE®MENT RECORD ID <br /> ❑ ❑ 5. Lagooning Z/ —7 6 <br /> ❑ ❑ 6. Compostin The items below re resent code violations and must be corrected: <br /> Structure Operation Bird DISPOS <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> 11 8. A r ed Concrete Tank <br /> r <br /> ❑ ❑ 9. Re oval from Premises J 'U e <br /> Structure Operation Vect r Control <br /> ❑ 10 Domestic FI <br /> ❑ Fannia Fl <br /> ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17eavy Population <br /> Structure Aperation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ture <br /> El 20. Food Stora <br /> StrOperation Houses <br /> ❑ 2l. Floors <br /> ❑ 0 22. Walls/Ceilings ' <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL.. <br /> Structure Operatio Water gleee <br /> ❑ ❑ Weli Construction /h <br /> ❑ ❑ 2. Cr Connection <br /> Structure operatio Floors <br /> El roperly Graded to <br /> El ElDrain c <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin ®� � <br /> -,e <br /> et <br /> ❑ 7. Claning Frequency q� cs <br /> Structure Operat @ alls <br /> ❑ mooth/Cleanable <br /> ❑ ❑ Cleaning Frequency <br /> Structure Operstio Cages <br /> ❑ ❑ . Condition <br /> ❑ ❑ 1 itation <br /> Structure Operation F <br /> ❑ ❑ tora e <br /> 11 ❑ 13. InsectAVermin <br /> Structure Operatio nimal Disposal <br /> ❑ ❑ rom Premises <br /> ❑ ❑ <br /> Structure Operatio Sewage DiS <br /> Af ('11 /'//1 1 <br /> 11 0 Septic System <br /> ❑ ❑ <br /> Structure OperaJR8.bi¢s Vacci RECEIVE BYINSPECTOR <br /> . Certificate on Premises A <br /> EHD 40-06 6/30/2005 Page: of_ <br />