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SAN JOAQUIN COUNTY <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> c m �c <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> POU TRY RANCH DB } INSPECTION DATE <br /> Structure Operation Water Well l.- <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ ❑ Cross-Connection C' <br /> Structure Operation Nanure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. preading and Disking <br /> ❑ ❑ 4. koncrete Tanks INSPECTION TYPE PROGRAM ELEMENT rRECORDID <br /> ❑ [15. Jgooning lV^ r <br /> ❑ ❑ 6. Cc posting The items below represent code violations and must be corrected: <br /> Structure Operation Bird D posal <br /> ❑ ❑ 7. BurAg Buwith 2"of Cover <br /> ❑ ❑ 8. Approed Concrete Tank <br /> Cl ❑ 9. Remov I from Premises y <br /> Structure Operation Vector Co trot <br /> ❑ ❑ 10. DomestV Fl <br /> ❑ ❑ 1 L Fannia Ayii <br /> ❑ ❑ 12. Larvae ezi C4-1;�- <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light PopAlation <br /> ❑ ❑ 16. Moderate 11ppulation � <br /> ❑ ❑ 17. Heavy Po ation e <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowl ®t3'�'y �® - Pew.® ✓` t <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings 1 � ' <br /> ❑ ❑ 1 23. Cleaning Fre uenc <br /> KENNEL �r , <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ 3. Properly Graded to <br /> U❑ El 4. Drain U <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ El 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure I Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> El El 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination E I'VED INSPEC <br /> F-10 18. Certificate on Premisesi, t ' <br /> EHD 40-06 6/30/2005 Page L Oi <br />