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SAN JOAQUIN COUNTY it <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95202 <br /> r VECTOR CONTROL INSPECTION FORM <br /> COMPUTER NO. J O O�{f Phone(209)468-3420 <br /> PERMIT NO. <br /> STR. OPER. DBA Inspection ate <br /> POULTRY RANCH (2,1-47x-e- O A 1J E G-6 RA^jc y <br /> WATER WELL Premise Address Recheck Dale <br /> -_ 1. WELL CONSTRUCTION <br /> -- 2. CROSS-CONNECTION <br /> MANURE MANAGEMENT THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> - - 3. SPREADING AND D19CING <br /> -- 4. CONCRETE TANKS <br /> -_ 5. LAGOONING <br /> - _ 6. COMPOSTING tt <br /> BIRD DISPOSAL eST Q s•G2 ��o �lrA �epePr WQ C inIoc�rVQd <br /> - - 7. BURYING WITH 2'OF COVER <br /> - _ 8. APPROVED CONCRETE TANK <br /> - - 9. REMOVAL FROM PREMISES �,�7n -t.- 40 /g co';i Oi04-- YIn Q K_,Ir"Q <br /> VECTOR CONTROL <br /> - - 10. DOMESTIC FLY r.�r ti d r w �:` �S a �( a�r�a¢e (�4.v'`�- <br /> - - 11. FANNIA FLY <br /> 12. LARVAE �.G CA-)t 1 d--^JaS AA-c G$$L2.qn <br /> - <br /> - - 13. PUPAE <br /> - - 14. ADULT //` � � <br /> -, 15. LIGHT POPULATION S1'Lore 0 r a V-C. `( 2 T YAG S IV`4 K.t.4.r l ra.e k+ + <br /> - - 16. MODERATE POPULATION <br /> 17. HEAVY POPULATION f Kms/-o lil%t2 W,'Ld/Vvj i!I ////K/Q 8' (/2=CTO <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 <br /> - _ 12. STORAGE <br /> -_ 13. INSECT/VERMIN <br /> ANIMAL DISPOSAL <br /> - - 14. REMOVAL FROM PREMISES <br /> - - 15. OTHER <br /> SEWAGE DISPOSAL <br /> - _ 16. SEPTIC SYSTEM <br /> - 17. SEWER [�- D <br /> RABIES VACCINATION �/JC r ' r"►c J (�( S'./K A I t_ <br /> -- 18. CERTIFICATE ON PREMISES <br /> Environmental Health gpecialist Received By <br /> Ob EH 07-01(600) <br />