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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /> a�FOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DB INSPECTION DATE <br /> Structure Operation Water Well 47 1� T <br /> ❑ ❑ 1. Well Construction PR MISE ADDRESS RE SPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management ®WNER/®PERATOR PHONE <br /> ❑ 3. Spreading Ad Disking <br /> ❑ 4. Concrete anks INSPECTION TYPE)) PROGRAM ELEMENT RECORD ID <br /> [15. Lagoon g y�KI / / <br /> ❑ 6. Com sting The items below represent code violations and must be corrected: <br /> Structure Operation Bird sposal <br /> ❑ 7. Birying with 2"of Cover <br /> ❑ 8. ipproved Concrete Tank <br /> ❑ ❑ 9 Removal from Premises A 0 <br /> ture J <br /> StrucOperation eClOr COn[rol <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ IN. Fannia FI <br /> ❑ EY 12. Larvae e <br /> ❑ 13. ae <br /> 14. ANplt <br /> ❑ <br /> t1118. <br /> 15. Li Po ulation <br /> El16. Mode to Po ulation �i � je <br /> ❑ 17. Heav ulation <br /> Struct re Feeding/Wat Water Trou s <br /> ❑ ❑ 19. Cups or Bow <br /> ❑ 0 20. Food Storage <br /> e <br /> Structure Operation Houses f t <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction d �he,5 ✓�� <br /> ❑ ❑ 2. Cross Connection y <br /> 3+P <br /> Structure Operation Floors -Sf ® t <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ 0 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ 0 7. CleaninR Fre uenc <br /> Structure Operation Walls <br /> ❑ 8. Smooth/Cleanable <br /> El El 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ ll. Sanitation <br /> Structure Operation Food <br /> ❑ El 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ 0 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ D 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIV INSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />