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°°"' SAN JOA I COUNTY <br /> o " <br /> c <br /> ENL ONMENTAL HEALTH DEPARTMEP <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 /> oQ <br /> �tppR <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA l INSPIECTION DATE <br /> i - <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Con ruction PREMISE ADDRESS REINSPECTION DATE <br /> ❑ 2. Cross-Con ction :,: <br /> Structure Ope tion Manure Ma gement ®WNER/OPERATOR PHONE <br /> ❑ 3. Spreadin and Disking iV 14 <br /> ❑ ❑ 4. Concrej Tanks INSPECTION VfPE PROGRAM ELEMENT R RD ID <br /> ❑ 5. Lago ing <br /> ❑ ❑ 6. Cc posting The items below represent code violations and must be corrected: <br /> Structure Operation Bir4obisposal <br /> ❑ ❑ V./Burying with 2"of Cover <br /> ❑ 13 A Approved Concrete Tank <br /> ' A <br /> ❑ [39. emoval from Premises Vis.. <br /> Structure Operation VeC r Control <br /> ❑ ❑ 10. D mestic FI <br /> ❑ ❑ 11. Fan is FI <br /> 12. Lary <br /> ❑ 14 13. Pu ae <br /> 14. Adult 'C <br /> 13 ❑ 15. Light Poikilation <br /> ❑ ❑ 16. Moderate hopulation <br /> ❑ ❑ 17. Heavy Pop ation <br /> Structure Operation Feeding/Water h <br /> ❑ ❑ 18. Water Trou <br /> r <br /> ❑ ❑ 19. Cu2s or Bowl <br /> ❑ ❑ 20. Food Storage p <br /> Structure Operation Houses ir. 0 <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings V, <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> K E N N E L <br /> Structure Operation Water Well <br /> ❑ El 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> El ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> El E3 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 /> ❑ El 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 0 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure operation Rabies Vaccination R E VED BY INSPE R <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />