COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAN J O A Q U I N Environmental Health Department _..-COUNTY---- DAIRY FARM EMPLOYEE HOUSING ANNUAL PERMIT EXEMPTION SELF-AUDIT HOUSING INSPECTION CHECKLIST COMPLETE ONE CHECKLIST FOR EACH HOUSING UNIT FACILITY NAME: —IA?A- !Vf —'.Lie-- PR#: LOCATION: " I ^t 1"' ' • r �' MAP DESIGNATION: HOUSING UNIT INFORMATION Address or identification number of unit:,r s- . a, ,; j y Date of Inspection: Type of Housing Unit: El Single Family Dwelling Mobile Home ❑Other: #Employees in Unit: Date Unit First Built or Installed: Electrical Power Provided By: Gas Provided by: HOUSING UNIT INSPECTION Interior Checkllst Comments Unit has hot and cold running water. okay ❑Needs Re air* Approved electrical power and gas fuel being supplied to Unit. key ❑Needs Repair* Heater maintained in functioning and safe manner(No space/portable heaters), o'bkay ❑Needs Repair* Doors and windows are accessible/operable to allow for safe exiting. [-Okay ❑Needs Re air* All rooms are clean and sanitary.No insect/rodent infestations present. key All appliances(stove,water heaters,air conditioning units,heaters are Needs ay air* properly vented strapped and are maintained in a safe,workingorder, 20k er. ❑Needs Repair* All smoke and carbon monoxide detectors are present and tested to be shown 04key in working order, ❑Needs Repair* All wiring in safe,working order(no splices,exposed wires,uncovered outlets). QOkay ❑Needs Repair* All plumbing in safe,working order(no leaks,properly maintained). Mdlkay Needs Repair* All counters,sinks,toilets,tubs,showers are working and in sanitary condition. ;gokay El All floors,walls,ceilings are free from holes,are not sagging or buckling,have ❑Needs Needs ay air' no water leaks and are clean and in good condition. eels Repair' Exterior Checklist Comments Roof is properly maintained with no holes,loose shingles,leaks,etc. --[-36k--ay ❑Needs Repair* Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. [3Okay Needs Repair* Stairways are safe with no rotting,deteriorating,or loose parts. [-Okay ❑Needs Repair* Propane tank has barrier protection and"No Smoking"signage. LjOkay ❑Needs Repair* The trash cans are sufficient in size,have lids and are picked up weekly, /-Okay ❑Needs Repair*. The electrical panel is covered and protected from tampering. Jjbkay ❑Needs Repair* The gas fuel connection is as approved and safe. 00kay ❑Needs Repair* There are no insect or rodent infestations, [-6kay Needs Repair* The sewage system is functioning,with no surfacing wastewater or backup, �}Okay ❑Needs Repair* *Needs Repair Please s ecif date re airs to be com leted.Any BuIldinq Permits required for repairs must be obtained and finaled. I certi thatI have Inspected the abov noted unit and that the Information provided is true and correct to the best of m knowledge. SIGNED: DATE TITLE ' 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com