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oP°uiN P SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTME T <br /> ra Floor, Stockton,CA 95202-2708 <br /> y: Telephone:(209)468-3420 Foix:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBAItNSPE IOND TE <br /> Structure Operation Water Well r� r <br /> log/og <br /> ❑ ❑ 1. Well Construe on PREMISE ADDRESVj REINSPECTI N DATE <br /> ❑ ❑ 2. Cross-Gonne tion <br /> Structure Operation Manure Ma gement OWNER/OPERATOR PHONE `� <br /> C] E] 3. Spreadi and Disking ffi r <br /> ❑ ❑ 4. Concre Tanks INSPECTION TY E PROGRAM ELEMENT RECORD ID <br /> 1:1 E] 5. Lago ing �+ D <br /> ❑ ❑ 6. Cor4osting The items below represent code violations and must be corrected: <br /> Structure Operation Bird 4sposal <br /> ❑ ❑ 7. l3king with 2"of Cover <br /> ❑ ❑ 8. roved Concrete Tank ®' <br /> ❑ ❑ 9. Removal from Premises ` <br /> Weil 1 [ <br /> Structure Operation ector Control <br /> ❑ ❑ 0. Domestic Fly__ -fn lorD±9C± SbC1ACtWTt' <br /> ❑ El 11. Fannia Fl <br /> ❑ ❑ A 12. Larvae <br /> ❑ ❑ 13. Pupae c <br /> ❑ 0 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population Su Stgm <br /> ❑ 17. Heavy Population <br /> Structure OIleration Feeding/Water <br /> ❑ ❑ 18. Water Troughs YK <br /> ❑ ❑ 19. Cups or Bowls ` r <br /> 11 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors r <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Frequenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction dS ME s <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors To 95 l,/ <br /> f <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 0 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls 0- ` <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> 13 ❑ 12. Storage <br /> ❑ El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> 1-1 ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System t <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination Y INSPE <br /> ❑ ❑ 18. Certificate on Premises MDAqw, I <br /> EHD 40-06 6/30/2005 Page of <br />