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SAN JOAQUIN COUNTY 40 <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95202 <br /> VECTOR CONTROL INSPECTION FORM <br /> COMPUTER NO. r Q So t7�l Phone(209)468-3420 <br /> PERMIT NO. 0C)S1 Sg <br /> STR. OPER. DBA Inspectio7�/q <br /> POULTRY RANCH C-A gT-60,. 02-,DA-,b F6,& 02A-,)C-9 g' <br /> WATER WELL Premise Address Recheck Date <br /> - - 1. WELL CONSTRUCTION 3 C)(o 3(o ,CAL-Q-71C fl- a-6 �7A{�I <br /> MANURE MANAGEMENT U I'i&! A-) <br /> -- 2. CROSS-CONNECTION <br /> THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> - - 3. SPREADING AND DItCING �el rs,9ec -71 Il w,*4, <br /> -- 4. CONCRETE TANKS I <br /> - 5. LAGOONING <br /> _ - 6. COMPOSTING <br /> BIRD DISPOSAL u�`'ti s 1,r -f" -�Ia 6reeol�.� �✓as o✓se�1..e�! ••� <br /> - - 7. BURYING WITH 2'OF COVER <br /> - - 8. APPROVED CONCRETE TANK <br /> - _ 9. REMOVAL FROM PREMISES Q C�1/?T✓1 - /�0 K°Gdr GaJQS dCCu b,or/ <br /> VECTOR CONTROL <br /> - - 10. DOMESTIC FLY 1`3 ` 14 <br /> - 11. FANNIA FLY <br /> - - 12. LARVAE / /o K tt S !��✓t .1.r r c�� G�2 ct n e .� f <br /> tic2 a. <br /> 13. PUPAE <br /> - - 14. ADULT <br /> J � <br /> 15. LIGHT POPULATION �edd!•c prG� a.•G� , �,„r aaaC ! 71a <br /> - - 16. MODERATE POPULATION <br /> - - 17. HEAVY POPULATION (y•.�q✓Uu! �/e y ak./,�,iLl d if +� rVA-a-kt-r a j. <br /> FEEDING/WATERyG /\ qpl w�f /,� <br /> - - 18. WATER TROUGHS <br /> _ - 19. CUPS OR BOWLS <br /> - - 20. FOOD STORAGE <br /> HOUSES J�i <br /> � T� <br /> -- 21. FLOORS <br /> -- 22. WALLS/CEILINGS Ga lC L� SCu. %,-e-, to,., ���Ar- - <br /> - - 23. CLEANING FREQUENCY <br /> rfee ,arc c- • 7rc DoS'7` <br /> STR. OPER. cS t.a.�/J,pD f Sf�'r ("O rrN1CGT Q 9 9� <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 /> 13. INSECTNERMIN <br /> ANIMAL DISPOSAL <br /> - - 14. REMOVAL FROM PREMISES <br /> - _ 15. OTHER <br /> SEWAGE DISPOSAL <br /> 16. SEPTIC SYSTEM <br /> - _ 17. SEWER <br /> RABIES VACCINATION /124,��14S � <br /> - - 18. CERTIFICATE ON PREMISES <br /> E ironmental Health Speci list Received By <br /> 0 EM 07-01(690) 44O Q-0 13'"(/ <br />