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SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 2009, ST ON, CA 95202 <br />VECTOR CONTROL INSPECTION FORM <br />COMPUTER NO. <br />PERMIT NO. ' �T <br />STR. OPER. <br />POULTRY RANCH <br />WATER WELL <br />1. WELL CONSTRUCTION <br />2. CROSS -CONNECTION <br />MANURE MANAGEMENT <br />3. SPREADING AND DNCING <br />4. CONCRETE TANKS <br />5. LAGOONING <br />6. COMPOSTING <br />BIRD DISPOSAL <br />7. BURYING WITH 2' OF COVER <br />8. APPROVED CONCRETE TANK <br />9. REMOVAL FROM PREMISES <br />VECTOR CONTROL <br />10. DOMESTIC FLY <br />11. FANNIA FLY <br />12. LARVAE <br />13. PUPAE <br />14. ADULT <br />15. LIGHT POPULATION <br />T _ 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 <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 <br />RABIES VACCINATION <br />_ _ 18. CERTIFICATE ON PREMISES <br />0 EH 07-01 (640) <br />0 <br />Phone CM) 468-U20 <br />Inspection Date <br />Premise Address Recheck Date TH4K eel <br />E ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br />p <br />