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r 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. <br /> Phone(204)468-3420 <br /> PERMIT No. <br /> STR. OPER. DBA Inspection Date <br /> POULTRY RANCH I <br /> WATER WELL Premise Address I Recheck Date <br /> -- 1. WELL CONSTRUCTION C <br /> 2. CROSS-CONNECTION <br /> THE ITEMS BELOW REPRESS T CODE VIOLATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> -- 3. SPREADING AND D19CING <br /> -_ 4. CONCRETE TANKS <br /> _- <br /> S. 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 /> 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 VACCINATM <br /> - I& CERTIFICATE ON PREMISESlu� <br /> gA A I PEIVED BY <br /> M EH O7-0t(6601 <br />