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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. Phone(209) 20 <br /> PERMIT NO. <br /> STR. OPER. DBA inspection Date <br /> POULTRY RANCH Sel 610 Mit i7-e .e: 17- - 7 -17 <br /> _ <br /> WATER WELL Prempire Address Recheck Date <br /> - 1. WELL CONSTRUCTION / / 1 W , / <br /> ®® 2. CROSS-CONNECTION <br /> THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> ® _ 3. SPREADING AND DIrCCING <br /> ® 4. CONCRETE TANKS <br /> - - S. LAGOONING <br /> 6. COMPOSTING i- / <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 /> - ® <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 AA <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 /> ® - 0 V- <br /> 7. CLEANING FREQUENCY <br /> WALLS <br /> - e 8. SMOOTH/CLEANABLE <br /> ®® 9. CLEANING FREQUENCY <br /> Vy- <br /> CAGES <br /> - s 10. CONDITION <br /> - - 11. SANITATION <br /> FOOD <br /> -- 12. STORAGE <br /> - 13. INSECT/VERIN <br /> ANIMAL DISPOSAL <br /> 14. REMOVAL FROM PREMISES <br /> - 15. OTHER <br /> SEWAGE DISPOSAL <br /> 1 <br /> 16. SEPTIC SYSTEM <br /> 17. SEWER <br /> RAINES VACCINATIONe° <br /> -- 18.CERTIFICATE ON PREMISES <br /> Enviro ental Health Specialist Rece ed By <br /> M EN 07-09 ) <br />