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SAN JOAQUIN COUNTY fo <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)468-3420 <br /> PERMIT NO. <br /> STR. OPER. DBA inspection <br /> �Date <br /> POULTRY RANCH C(2R QC /� co <br /> WATER WELL Premise Address Recheck Date <br /> _79e 1. WELL CONSTRUCTION <br /> 2. CROSS-CONNECTION rJ <br /> THE ITEMS BELOW REPRESENT CODE VIOLATIONS AND MUST BE CORRECTED: <br /> MANURE MANAGEMENT <br /> -_ 3. SPREADING AND DIGGING <br /> 4. CONCRETE TANKS <br /> _L1 5. LAGOONING C' <br /> - - 6. COMPOSTING <br /> BIRD DISPOSAL <br /> 7. BURYING WITH 2'OF COVER <br /> 8. APPROVED CONCRETE TANK r <br /> 9. REMOVAL FROM PREMISES ✓/- <br /> VECTOR CONTROL <br /> r <br /> 10. DOME TIC FLY <br /> T 11. FANNIA(FLY / <br /> -- 13. PUPAE /14 <br /> 9. L/ �iL t <br /> 14. ADULT VVV <br /> - LIGHT POPULATION <br /> -- 16. MODERATE POPULATION <br /> -- 17. HEAVY POPULATION omd <br /> FEEDING/WATER <br /> td18. WATER TROUGHS <br /> fm m CUPS OR BOWLS <br /> - _ 20. FOOD STORAGE <br /> HOUSES <br /> _�j 21. FLOORS <br /> �:L 22. WALLS/CEILINGS <br /> - _ 23. CLEANING FREQUENCY /� _ J ✓ <br /> STR. OPER. /v <br /> KENNEL <br /> WATER WELL L / <br /> -- 1. WELL CONSTRUCTION <br /> - - 2. CROSS CONNECTION <br /> FLOORS r <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 r <br /> 9. CLEANING FREQUENCY ✓6�� <br /> CAGES <br /> - _ 10. CONDITION <br /> -_ 11. SANITATION <br /> PeA <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 VACCINATIONY, / r7 vfv <br /> � <br /> -- 18. CERTIFICATE ON PREMISES SANT I N REIV D BY <br /> 0) EH 07-01(690) <br />