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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 /> �F 4_ <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA INSPECT NDAT <br /> StructureME12. <br /> ater Well ' 1 <br /> 45) <br /> ❑ Well Construction PREMISE ADDRESS REINS ECTIO DATE <br /> ❑ Cross-ConnectionStructureanure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning t <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Bulying with 2"of Cover <br /> ❑ 0 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises 1 1/ / <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> El F112. Larvae �/ �l� �'S1�1Y`�ii^�`�l� �AIe--5 <br /> 0 11 13. pupae If <br /> ❑ 14. Adult 1,,�� <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ D 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ I ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls 4wa <br /> ❑ 20. Food Storage <br /> r fA <br /> Structure Operation Houses I �.11` <br /> ❑ ❑ 21. Floors <br /> r <br /> ❑ 1 0 1 22. Walls/Ceilings L,1itA <br /> ❑ ❑ 1 23. Cleaning Frequency p ® f-:411 <br /> f J <br /> K E N N E L �+�fsC Vk--e, 5i'd e ® -:4 L <br /> Structure Operation Water Well _ e <br /> ❑ ❑ 1. Well Construction / <br /> ❑ 11 2. Cross Connection <br /> s <br /> Structure Operation Floors r` r�. <br /> ❑ ❑ 3. Properly Graded to <br /> Cl ❑ Drain <br /> ❑ ❑ 5. mooth/Cleanab <br /> ❑ ❑ 6. koving <br /> ❑ El 7. C aning Fr uenc <br /> A <br /> Structure Operation Wallsk 12e-- e p <br /> ❑ 0 8. Smo Cleanable <br /> ❑ 11 9. C,cAg Frequency a <br /> Structure Operation Cag <br /> ❑ ❑ 10 Conditi <br /> ❑ ❑ . Sanitation <br /> Structure Operation Aood <br /> ❑ 0 12. Storage <br /> ❑ t- <br /> El <br /> 13. Insect/Verrnin <br /> Structure Animal Disposal <br /> ❑ 14. Removal from Pr ises <br /> ❑ 15. Other <br /> Structure Sewage Disposal <br /> 16. Septic System <br /> ❑ El 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br />