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P°"1N <br /> ARONMENTAL <br /> SAN JOAQUIN COUNTY <br /> HEALTH DEPARTM NT <br /> N" 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 /> Cq���FpRN�P <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANC DBA INNSSPE 0OND TE <br /> Structure Operation Water Well K•h•C_dl- t-VJ�j / L� dS <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS REINSPECTI N DATE <br /> ❑ ❑ 2. Cross-Connection 9,L4 5 G h S • I •`� <br /> Structure Operation Manure Management OWNER/OPERATOR //11 PHONE <br /> 11 [13. Spreading and Disking W / <br /> W t� &� 3 2. 36 p 77' <br /> ❑ ❑ 4. Concrete Tanks INS ECTION PE PROGRAM/ELEMENT RECORD ID <br /> 11 ❑ 5. Lagooning rN-- Lt I G Doa <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal 11 <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> El 9. Removal from Premises � �+ t9t t44- <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic Fl <br /> ❑ ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult t <br /> ❑ ❑ 15. Light Population JJ� ,,_,,��.,__pp <br /> 11 El 16. Moderate Population /�I o"'Sn"�"�` ,' ouc + <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water 1 <br /> ❑ ❑ 18. Water Troughs 1 \ <br /> 11 El 19. Cups or Bowls �dt"O� Ste` �- <br /> ❑ ❑ 20. Food Stora e <br /> Structure Operation Houses c7 <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilin s (ilk <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL O- <br /> Structure Operation Water Well J <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection iiq <br /> Structure Operation Floors O <br /> ❑ ❑ 3. Properly Graded to V ` <br /> 11 El 4. Drain V✓o►- <br /> ❑ ❑ 5. Smooth/Cleanable 10, <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency D 6-4- <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 /> ❑ 1 ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSP <br /> ❑ ❑ 18. Certificate on Premises <br /> EHD 40-06 6/30/2005 Page_of <br />