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1 pU1N s <br /> -•.co l .WAN JOAQUIN COUNTY <br /> a' E 'VIRONMENTAL 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 /> C4C O�R�`P <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECT <br /> ON DA <br /> /r <br /> Structure Operation Water Well 4-. V-.V) 'L t 0 S <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESSt R NSPEC ON DATE <br /> ❑ ❑ 2. Cross-Connection U L �In V V,., < <br /> Structure Operation Manure Management OWNER/OPERATO�R" ,[PHONE <br /> ❑ ❑ 3. Spreading and Disking �„�� t V v C- ( e- C w t' � 7�,� '1 c��-0 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION PE ( P�RjOGRAM ELEMENT R CORD ID <br /> ❑ ❑ 5. Lagooning 0 4 c• �'l / 0� L)/.)a <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover C_ <br /> ❑ ❑ 8. Approved Concrete Tank ! <br /> I ❑ ❑ 9. Removal from Premises <br /> Structure Operation Vector Control !� <br /> ❑ ❑ 10. Domestic Fl <br /> j ❑ ❑ 11. Fannia FI <br /> f ❑ ❑ 12. Larvae <br /> 11 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population 0 t.! " - a t-1 <br /> ❑ ❑ 17. Heavy Population J <br /> Structure Operation Feeding/Water Water a r r M. c•%cx t''t <br /> ❑ ❑ 18. Water Troughs �1 <br /> ❑ ❑ 19. Cups or Bowls r +1" =� �z,/"� ! 1 iU C"-�-e <br /> ❑ ❑ 20. Food Storage 1 <br /> Structure Operation Houses :. •-' 1 y s- 1./\ c "�'! C'" " <. <br /> ❑ ❑ 21. Floors ,�y, / (, <br /> El 22. Walls/Ceilings y' (a ✓•'1,. \ <br /> ❑ ❑ . ing Frequency <br /> ~K E N N E L l+u -(1.z f 117 r\ LA f <br /> Structure Operation ater Well <br /> 11 1. Well Construction d <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors P r "'i e.�. �', 11 <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 /> ❑ ❑ 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 RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises " <br /> EHD 40-06 6/30/2005 - I' _ ._ r <br /> Page-/ of <br />