Laserfiche WebLink
RECEIVED <br /> SAN JOAQUIN COUNTY JAS! 2 8 2022 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 LNVIItO:\,OII.NTAL hILAL(hI <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd ')LJ)IAIZI NILN'C <br /> DAIRY FARM EMPLOYEE HOUSING <br /> ANNUAL PERMIT EXEMPTION SELF-AUDIT HOUSING INSPECTION CHECKLIST <br /> COMPLETE ONE CHECKLIST FOR EACH t 1OUSING UNIT <br /> FACILITY NAME: CAT014 A�Zp►5 'D/v; PR#: <br /> LOCATION: SCAtC," I MAP DESIGNATION: <br /> HOUSING UNIT INFORMATION <br /> Address or identification number of unit: Date of Inspection: <br /> Type of Housing Unit: ❑ Single Family Dwelling ❑ Mobile Home ❑ Other. <br /> #Employees in Unit: Date Unit First Built or Installed: <br /> Electrical Power Provided By: Gas Provided by: <br /> HOUSING UNIT INSPECTION <br /> Interior Checklist Comments <br /> Unit has hot and cold running water. ❑okay <br /> ❑ Needs Repair* <br /> Approved electrical power and gas fuel being supplied to Unit. ❑Okay <br /> ElNeeds Repair* <br /> Heater maintained in functioning and safe manner(No space/portable heaters). ❑Okay <br /> ❑Needs Repair* <br /> Doors and windows are accessible/operable to allow for safe exiting. ❑Okay <br /> ❑ Needs Repair* <br /> All rooms are clean and sanitary.No insect/rodent infestations present, []Okay <br /> ❑Needs Repair* <br /> All appliances(stove,water heaters,air conditioning units,heaters)are properly vented, ❑Okay <br /> strapped and are maintained in a safe,working order. ❑Needs Repair* <br /> All smoke and carbon monoxide detectors are present and tested to be shown in working ❑Okay <br /> order. ❑Needs Repair* <br /> All wiring in safe,working order(no splices,exposed wires,uncovered outlets). ❑Okay <br /> ❑ Needs Repair* <br /> All plumbing in safe,working order(no leaks,properly maintained). ❑Okay <br /> ElNeeds Repair* <br /> All counters,sinks,toilets,tubs,showers are working and in sanitary condition. ❑Okay <br /> ❑ Needs Repair* <br /> All floors,walls,ceilings are free from holes,are not sagging or buckling,have no water ❑okay <br /> leaks and are clean and in good condition. ❑ Needs Repair* <br /> Exterior Checklist Comments <br /> Roof is properly maintained with no holes,loose shingles,leaks,etc. ❑Okay <br /> ❑ Needs Repair* <br /> Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. ❑Okay <br /> ❑ Needs Repair* <br /> Stairways are safe with no rotting,deteriorating,or loose parts. ❑Okay <br /> ❑ Needs Repair* <br /> Propane tank has barrier protection and"No Smoking"signage. ❑Okay <br /> ❑Needs Repair* <br /> The trash cans are sufficient in size,have lids and are picked up weekly. ❑okay <br /> ❑Needs Repair* _ <br /> The electrical panel is covered and protected from tampering. ❑Okay <br /> ❑ Needs Repair* <br /> The gas fuel connection is as approved and safe. ❑Okay <br /> ❑ Needs Repair* <br /> There are no insect or rodent infestations. ❑okay <br /> ❑Needs Repair* <br /> The sewage system is functioning,with no surfacing wastewater or backup. ❑Okay <br /> ❑ Needs Repair* <br /> *Needs Repair: Please specify date repairs to be completed. Any Building Permits required for repairs must be obtained and finaled. <br /> I certify that I have inspected the above noted unit and that the information provided is true and correct to the best of my knowledge. <br /> SIGNED BY: <br /> NAME DATE TITLE <br /> EH 27-XX 9/20/2013 Dairy Farm Employee Housing <br />