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• SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95202 <br /> �J VECTOR CONTROL INSPECTION FORM <br /> COMPUTER NO. p S ✓� Phone(209)468-3420 <br /> PERMIT NO. P1 0©O S� <br /> STR. OPER. DBAInspection Date <br /> POULT RANCH ` �� G� _7 ' 7 <br /> 1 i <br /> WATER W L Premise Address Recheck Dale <br /> . WELL CONSTRUCTION / <br /> 2. CROSS-CONNECTION l J� <br /> MANURE NT THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> 3. EADING AND DIKING <br /> _ 4. C RETE TANKS <br /> _ 5. LA OOHING <br /> 6. C TING <br /> BIRD DISPOSAL <br /> BURY1 G W H 2'OF COVER <br /> APPR CONCRETE TANK <br /> 9. REMOV FROM PREMISES <br /> VECTOR CONTRO <br /> _ 10. STIC LY <br /> _ 11. AMNIA FL <br /> 12LARVAE <br /> . PUPAE <br /> 14. ADULT <br /> 15. LIGHT POPULA ION <br /> 16. MODERATE PO LATION <br /> 17. HEAVY POPULA ON <br /> EDING/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 WA <br /> 7R WELL <br /> 1. WELL CONSTRUCTION L6 _ <br /> 2. CROSS CONNECTION <br /> FLOORS <br /> _ 3. PROPERLY GRADED TO SEWER <br /> -�,Z- 4. DRAIN <br /> 5. SMOOTH/CLEANABLE <br /> 6. COVING <br /> -\Z_ 7. CLEANING FREQUENCY <br /> WALLS <br /> 8. SMOOTH/CLEANABLE <br /> _ 9. CLEANING FREQUENCY <br /> CAG/ES <br /> �G 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 /> SEW GE DISPOSAL <br /> 16. SEPTIC SYSTEM <br /> 17. SEWER <br /> RAS VACCINATION <br /> �-- 18. CERTIFICATE ON PREMISES <br /> Environmental Health Specialis Received By <br /> 0 EH 07-01(8-00) <br />