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,o c® SAN JOAQUIN COUNTY <br /> 2 ENVIRONMENTAL 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 /> <<Fog <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA a INSPECzfq/o&ON DATE <br /> Structure Operation Water Well 1 VN 1 ✓°�^-,7 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSOECTioN DATE <br /> ❑ ❑ 2. Cross-Connection t <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE i �y <br /> ❑ ❑ 3. Spreading and Disking 1A4� LA / <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 1 raj / a <br /> 4-0003 Lk <br /> ❑ ❑ 6. Composting The items delow represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ 0 8. Approved Concrete Tank <br /> r � <br /> ❑ ❑ 9. Removal from Premises l� ^ <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ 11. Fannia Fl { <br /> ❑ ❑ 12. Larvae <br /> ❑ D 13. Pupae J. <br /> jj <br /> El El 14. Adult P (L., <br /> ❑ 0 15. Light Population <br /> ❑ El 16. Moderate Population <br /> ❑ El 17. Heavy Population <br /> Structure Operation Feeding/Water 91a, C y S <br /> ❑ ❑ 18. Water Troughs <br /> ❑ 0 19. Cups or Bowls ,►^ o s 1 r"- <br /> ❑ 0 20. Food StoraLe <br /> r <br /> Structure Operation Houses ( �' <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> KENNEL <br /> Structure Operation Water Well <br /> 11 0 1. Well Construction <br /> 2. Cross Connection <br /> St tore Operation Floors <br /> ❑ 3. Properly Graded to <br /> 4. Drain <br /> ❑ N8. <br /> . Smooth/Cleanab❑ . Covin❑ . Cleanin F uencStructurealls <br /> ❑ Smoot Cleanable <br /> El . Cle in Fre uencStructureag¢❑ 0 Condition <br /> ❑ Sanitation <br /> Structure OperationOo <br /> ❑ El 12. S rage <br /> ❑ ❑ 13. Ins t/Vermin <br /> Structure ope on Animal 'sposal <br /> ❑ 14. Remov from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation t16. <br /> age Dispo 1 <br /> ❑ S tic S Ste <br /> ❑ ❑ 17. Sewer <br /> Stru re Operation Rabies Vaccination RECEIVED BY INSPEC <br /> 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page Of <br /> q6-,r -zn-z, <br />