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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. F/KQ t/0001�f,� Phone(209)468-3420 <br /> PERMIT NO. l-600 7 I 3P,L <br /> STR. OPER. DBA Inspection Date <br /> POULTRY RANCH K, L5 0 1 k)r- (fA --M l l Y <br /> WATER WELL Premise Address Recheck Date <br /> 1. WELL CONSTRUCTION 7/ fbly 1 9 <br /> 2. CROSS CONNECTION <br /> THE ITEMS BELOW REPRESE T CODE VIOLATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> %DISPOSAL <br /> NG AND DICCI <br /> _ TE TANKS <br /> ING <br /> _ TINGBIROGWIT 2'OF COVERED ONCRETE TANK <br /> 9. REMOV L ROM PREMISES <br /> VECTOR ;14. <br /> ROL <br /> DOME K: LY <br /> FAN A FL <br /> _ LA VAE <br /> PAE <br /> DULT <br /> LIGHT POPULATION <br /> MODERATE POPULATION <br /> HEAVY POPULATION <br /> FEEDINGER <br /> _ 18. WATER TROUGHS <br /> 19. CUPS OR BOWLS <br /> 20. FOOD STORAGE <br /> HOUSES L(/ 1I 4,40x A <br /> _ 21. FLOORS <br /> 22. WALLS/CEILINGS <br /> _ 23. CLEANING FREQUENCY <br /> STIR. OPER. <br /> KENNEL <br /> WATER WELL <br /> 1. WELL CONSTRUCTION <br /> 2. CROSS CONNECTION <br /> FLOORS <br /> �3. PROPERLY GRADED TO SEWER <br /> -Le-'4. DRAIN <br /> SMOOTH/CLEANABLE <br /> 14' COVING <br /> 7. CLEANING FREQUENCY <br /> WALLS <br /> 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 D SAL <br /> 14. REMOVAL FROM PREMISES <br /> _ 15. OTHER <br /> SEWAGEOSAL <br /> 16.,SEPTIC SYSTEM <br /> _ 17. SEWER <br /> RABIES VACCINATION <br /> —_ 18. CERTIFICATE ON PREMISES SANITARIAN _ CEAVED BY <br /> ® EH 07.01 Io-ool <br />