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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <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 /> ��FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA , INSPEc ION DATE <br /> Structure Operation Water WCII 1 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REI PECTIO DATE <br /> ❑ 2. Cross-Co ection <br /> St cture Operation Manure M agement ® ER/OPERATOR PHONE <br /> ❑ 3. Spread g and Disking <br /> EX ❑ 4. Conc to Tanks INS ECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ N ❑ 5. La@6oning <br /> ❑ 6. V6 posting The items below represent code violations and must be corrected: <br /> Structure ,,ration Bi Disposal <br /> ❑ Burying with 2"of Cover <br /> ❑ <br /> A. A2proved Concrete Tank P <br /> 11 ❑ 9. Removal from Premises l <br /> Structure Operation vector Control <br /> 10. Domestic FI <br /> ❑ V. Fannia FI p <br /> ❑ <br /> A Larvae <br /> ❑ 13 N&pae <br /> ❑ El 14. ult ( " <br /> ❑ El 15. Li t Population <br /> El E] 16. Mo ate Population <br /> 11 El 17. HeavyNopulation s t <br /> Structure Operation Feeding/Wa r <br /> ❑ ❑ 18. Water Trou s <br /> 19. Cups or Bowls tJ / <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s <br /> ❑ ❑ 23. Cleanin Frequenc <br /> KENNEL <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ El 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 Cages <br /> ❑ ❑ 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 /> ❑ ❑ 17. Sewer- <br /> Structure Operation Rabies Vaccination C INSPECT <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page J of <br />