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PQ U i N SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN <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 /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPE TION DATE <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REIfSPECT16N DATE <br /> ❑ ❑ 2. Cross-Connection +^ <br /> Structure Operation Manure Managment OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreadin nd Disking <br /> ❑ ❑ 4. Concre Tanks INSPWTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagog6ing <br /> ❑ ❑ 6. Co posting The items below represent code violations and must be corrected: <br /> Structure Operation Birdbisposal <br /> ❑ ❑ 7. urying with 2"of Cover <br /> VApproved Concrete Tank <br /> Cl N A. Removal from Premises 1 <br /> Structure Ower 'on Vector Control tt <br /> ❑ EIV 10. Domestic Fl t <br /> ❑ EA 11. Fannia Fl <br /> 12. Larvae <br /> ❑ 13. Pupae <br /> s <br /> ❑ 4. Adult do,5 / <br /> ❑ 1 Light Po ulation <br /> ❑ ❑ 16\Moderate Population <br /> ❑ 11 17. eavy Population r <br /> Struct a Operation Feedi at¢r <br /> 18. Wat Troughs <br /> ❑ El 19. Cups or Bowls f <br /> 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> K E N N E L <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> r <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> 11 ❑ 4. Drain <br /> 171 ❑ 5. Smooth/Cleanable <br /> ❑ 0 6. Covin <br /> ❑ ❑ 7. CleaningFre uenc <br /> Structure Operation Walls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ El 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> 11 ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSP <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />