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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON,-C' 95202 <br /> VECTOR CONTROL INSPECTION FORM <br /> COMPUTER No. <br /> Phone(209)_468-U20 <br /> PERMIT NO <br /> STR. OPEN. DBA Inspection,Date <br /> POULTRY RANCH 1 <br /> WATER WELL Premise Address Rectte k Dite <br /> _ 1. WELL CONSTRUCTION <br /> ®- 2. CROSS-CONNECTION <br /> THE ITEMSBELOW'REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> 3. SPRMING AND DIKING <br /> - 4. CONCRETE TANKS <br /> - 5. LAGOONING L° <br /> 6. COMPOSTING <br /> BIRD DISPOSAL <br /> ® 7. BURYING WITH 2°OF COVER <br /> -- 8. APPROVED CRETE TANK <br /> - 9. REMOVAL FROM EMISES j <br /> VECTOR CONTROL <br /> - 1®. DOMESTIC FLY <br /> - 11. FANNIA FLY <br /> _ 12. LARVAE <br /> ® 13. PUPAE <br /> 14. ADULT <br /> ® 15. LIGHT POPULATION I+IkvkAg, l e s <br /> 16. MODERATE POPULATION <br /> ® 17. HEAVY POPULATION <br /> FEEDING/WATER _ r <br /> 18. WATER TROUGHS <br /> e 19. CUPS OR BOWLS i <br /> 20. FOODSTORAGE <br /> HOUSES t ku va <br /> tz <br /> 21. FLOORS <br /> 22. WALLS/CEILINGS <br /> ® 23. CLEANING FREQUENCY <br /> STR. OPER. <br /> KENNEL - <br /> WATER WELL <br /> _ 1. WELL CONSTRUCTION <br /> 2. CROSS CONNECTION <br /> FLOORS <br /> ® 3. PROPERLY GRADED TO SEWER <br /> - 4. DRAIN <br /> 5. SMOOTH/CLEANABLE <br /> 6. COVING <br /> 7. CLEANING FREQUENCY <br /> WALLS <br /> 8. SMOOTH/CLEANABLE <br /> - 9, CLEANING FREQUENCY <br /> CAGES <br /> 10. CONDITION <br /> 11. SANITATION <br /> FOOD <br /> 12. STORAGE <br /> -e 13. INSECT/VERMIN <br /> ANIMAL DISPOSAL <br /> ®_ 14. REMOVAL FROM PREMISES <br /> ® -r,r15. OTHER <br /> SEWAGE DISPOSAL <br /> - 16.,SEPTIC SYSTEM <br /> - - 17. SEWER <br /> RAINES VACCINATION <br /> 18.CERTFICATE ON PREMISES- - <br /> Environmental Healt pecialist Rceived.Hy <br /> EH 07-01 1 <br />