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oPout"' e SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME T <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 /> 4<)FQ-�ca <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA 11 tpBFQTION DATE <br /> Structure Operation Water Well aq� J <br /> ❑ 1. Well Construion PREMISE ADDRESS REINSPECTION D&E <br /> ❑ Ll 2. Cross-Gonne ion <br /> Structure Ope tion Manure ManqAement OWNER/OPERATOR PHONE <br /> ❑ 3. SpreadingAnd Disking ` <br /> ❑ ❑ 4. Concret Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagoo ing ' T <br /> ❑ ❑ 6. Co osting The items below represent code violations and must be corrected: <br /> Structure Operation Bird isposal <br /> ❑ ❑ 1 7. 4rying with 2"of Cover <br /> ❑ ❑ 8.Approved Concrete Tank y <br /> ❑ ❑ Removal from Premises / l w -- ' sr` <br /> Structure Operation Actor Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ II. annia Fl <br /> ❑ ❑ 12. krvae / <br /> ❑ 13. 4ae <br /> 14. Ad It <br /> ❑ Irl 15. Li h Population <br /> ❑ ❑ 16. Mode to Population IVO <br /> ❑ ❑ 17. Heav o ulation <br /> Structure Operation Feeding/Wa r <br /> ❑ El 18. Water Tr ghs <br /> t <br /> n- El 19. Cups or Bo is P016212 ,a <br /> ❑ 0 20. Food Stora <br /> Struc re Operation Houses <br /> El 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL 11 q <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction <br /> 11 ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation I Cages <br /> ❑ El 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> _ Structure Operation Food <br /> ❑ El 12. Stora e <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> Cl ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 0 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination ED Y INSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page of <br />