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T 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)4UW20 <br /> PERMIT NO. <br /> STR. OPER. DBA Insi��6 <br /> POULTRY RANCH v <br /> WATER WELL Premise Address 01 Recheck Date <br /> -- 1. WELL CONSTRUCTIONr l <br /> -- 2. CROSS-CONNECTION <br /> negze <br /> NT THE ITEMS BELOW REPRESENT CODE V ATIONS AND M BE CORRECTED: <br /> MANURE N. _ ,SPR DING AND D19CING l_.✓ S� �� �✓, �� <br /> -- 4. CONCRETE TANKS <br /> -- 5. LAGOONING ti <br /> -- 6. COMPOSTING <br /> BIRD DISPOSAL _ <br /> - - 7. BURYING WITH 2'OF COVERti <br /> -- 8. APPROVED CONCRETE TANK <br /> - _ 9. REMOVAL FROM PREMISES <br /> VECTOR CONTROL } <br /> - - 10. DOMESTIC FLY v <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 VACCINATION <br /> -- 18. CERTIFICATE ON PREMISES ANITARIAN RECEIVEt RY <br /> ® EH 07-01(coo) <br />