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4 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. ',�A yPhone(209)468-3420 <br /> PERMIT NO. $t d"? <br /> STR. OPER. DOA Inspection ate <br /> POULTRY RANCH GCI-iei�0-/4-06A" "Z 1 2-P-14� <br /> WATER WELL Premise Address Recheck bate <br /> - - 1. WELL CONSTRUCTION 3 7110-0 <br /> - - 2. CROSS-CONNECTION <br /> MANURE MANAGEMENT THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> _ 3. SPREADING AND DItCING (az.-Y # CD y3 Ewczss'V-L 4/i;,x <br /> - - 4. CONCRETE TANKS <br /> -- 5. LAGOONING <br /> - - 6. COMPOSTING <br /> BIRD DISPOSAL <br /> - - 7. BURYING WITH T OF COVER <br /> - - 8. APPROVED CONCRETE TANK // , l <br /> -- 9. REMOVAL FROM PREMISES GGQ eLC1� 'f"r/ kcG& ANifrCC a,d Iw gh , iOc(G dT <br /> VECTOR CONTROL / \ <br /> - - 10. DOMESTIC FLY /1-a►9.`4-r-e �`i ce�u✓e -f ttiKc� <br /> - - 11. AY <br /> L <br /> 12. LARVAERVAE ELI (,,iOrPr 5 /12a✓�r rr. cr Sfac�ccDa�e <br /> - - <br /> - - 13. PUPAE <br /> - - 14. ADULT 11 <br /> - - 15. LIGHT POPULATION /q-G �trc/{y I'D� 4L111d 12QCt7Z�{� <br /> -- 16. MODERATE POPULATION / 4 h <br /> 17. HEAVY POPULATION �-AU7y�Q-r-k� <br /> FEEDING/WATER V <br /> - - 18. WATER TROUGHS <br /> _ - 19. CUPS OR BOWLS <br /> - - 20. FOOD STORAGE <br /> HOUSES (e a (�vn o.iYV�-tJ ��I G�i cGK�►- YLa�yC.3ll�G <br /> - - 21. FLOORS ! 1 <br /> -- 22. WALLS/CEILINGS Y� (N GAP "td 6✓K4v.u.t r^C ✓t.-0vett <br /> - - 23. CLEANING FREQUENCYJ t1r p a-q- a. ,/ ,�c✓l G✓. <br /> Dw n ,.S 7T/ �G�/ c v/LLLi./ v-G "' ^^� CCA-1A d S I 6EA/"'C4_ <br /> STR. OPER. N -� •p,,,.,,,,1/ Q K GC GL Gt Ci I f' L nr TAp SO 'I <br /> KENNEL /✓O <br /> KENNEL - <br /> WATER WELL shjp�(1� o'� tilll .tiu.� cS 9Q�✓.�Iaeo( oft <br /> 1. WELL CONSTRUCTION <br /> - - 2. CROSS CONNECTION Gc 'I� fo2ca use vti T /N b r-«��.� L1Jet C <br /> FLOORS <br /> - - 3 PROPERLY GRADED SEWER �o <br /> - - 4. RAIN <br /> TH/CLEANA E <br /> - - 6. C ING <br /> -- 7. CL NTNG FR UENCY <br /> WALLS ✓2 c raS�lLc�'�L r�c. 6e- C-"'t C" tyt O 4 <br /> - - 8. SMOOT C EANABLE �`/Z�IOLB" <br /> - - 9. CLEANI FREQUENCY <br /> CAGES <br /> - - 10. CON TION <br /> - - 11. SA TATION <br /> FOOD <br /> - - 12. ORAGE <br /> -- 13. INSECT/VERMIN <br /> ANIMAL DI OSAL <br /> - _ 4. REMOVAL FROM PREMI S <br /> - - 15. OTHER <br /> SEWAG DISPOSAL <br /> 16. SEPTIC SYSTEM <br /> - 17. SEWER j' p <br /> RABIES VACCINATION ../KGs u•s. /{/q I C. 7/ l�j 6 <br /> -- 18. CERTIFICATE ON PREMISES <br /> Environmental Health gpecialist Received By <br /> $ EH 07-01(690) <br />