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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95202 <br /> VECTOR CONTROL INSPECTION FORM <br /> COMPUTER NO. TS 1OO Q, 4 Phone(209)468-3420 <br /> PERMIT NO. CA�) IL.C�I <br /> STR. OPER. DBA Inspection Date <br /> POULTRY RANCH h (✓` _ <br /> WATER WELL Premise Address _ R k D e <br /> 1. WELL CONSTRUCTION $5 ! p�y <br /> 2. CROSS-CONNECTION CCJ/J l►- L 1 <br /> THE ITEMS BELOW REPRESENT CODE VI CATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> 3. SPREADING AND DIKING <br /> 4. CONCRETE TANKS e <br /> -_ 5. LAG ING '( Q n��-0 AO6. COMPOSTINI <br /> BIRD DISPOSAL r M_ ►�{ �_1_w/1 w <br /> _ 7. BURYING WITH 2'OF COVER L,�' L ' <br /> _ 8. APPROVED CONCRETE TANK <br /> _ 9. REMOVAL FROM PREMISES <br /> VECTOR CONTROLE <br /> 10. DOMESTIC FLY ' <br /> _ 11. FANNIA FLY �. 144 <br /> _ 12. LARVAE <br /> 13. PUPAE <br /> _ 14. ADULT <br /> _ 15. LIGHT POPULATION <br /> _ 16. MODERATE POPULATION <br /> 17. HEAVY POPULATION <br /> FEEDING/WATER <br /> 18. WATER TROUGHS <br /> 19. CUPS OR BOWLS <br /> 20. FOOD STORAGE <br /> HOUSES <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 1� <br /> _ 12. STORAGE J` <br /> 13. INSECT/VERMIN <br /> ANIMAL DISPOSAL <br /> 14. REMOVAL FROM PREMISES <br /> - _ 15. OTHER _ <br /> SEWAGE DISPOSAL oin <br /> _ 16. SEPTIC SYSTEM <br /> 17. SEWER <br /> RABIES VACCINATION <br /> -_ 18. CERTIFICATE ON PREMISES <br /> 4Eiron ental Health Specialist dived By <br /> 0 Eli 0701(8-90) <br />