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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES lb <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95202 <br /> COMPUTER NO. <br /> VECTOR CONTROL INSPECTION FORM <br /> Phone(209)468-3420 <br /> -Q- <br /> PERMIT NO. � <br /> STIR. OPER. DBA jj Inspection Date <br /> POULTRY RANCH t�� � i jT <br /> WATER WELL Premise Address Rec k Date <br /> 1. WELL CONSTRUCTION ' . /V; <br /> 2. CROSS-CONNECTION <br /> THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> 3. SPREADING AND DIGGING <br /> 4. CONCRETE TANKS <br /> 5. LAGOONING / C <br /> 6. COMPOSTING <br /> BIRD DISPOSAL <br /> 7. BURYING WITH 2'OF COVER �y✓(�+ Com" -a i2� <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 /> STA. OPER. <br /> KENNEL <br /> WATER WELL �rf <br /> 1. WELL CONSTRUCTION y <br /> 2. CROSS CONNECTION <br /> FLOORS �� [J/ [ anc/ -I <br /> _ 3. PROPERLY GRADED TO SEWER <br /> 4. DRAIN <br /> _ 5. SMOOTH/CLEANABLE <br /> 6. COVING <br /> 7. CLEANING FREQUENCY <br /> WALLS (.� �'tk I/ <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 s <br /> __ 18.CERTIFICATE ON PREMISES I �A FINED BY <br /> ® EH 07-07(3-00) <br />