Laserfiche WebLink
SAN J OA Q U I N Environmental He <br /> --COUNTY a th Department <br /> DAIRY FARM EMPLOYEE HOUSING <br /> ANNUAL PERMIT EXEMPTION SELF-AUDIT HOUSING INSPECTION CHECKLIST <br /> COMPLETE ONE CHECKLIST FOR EACH HOUSING UNIT <br /> FACILITY NAME: Ia <br /> LOCATION: PR#: <br /> H SI G UNIT INFORMATIONf1 MAP DESIGNATION: <br /> Address or identification number of unit:�(� , `Lj > Date of Inspection: G' <br /> Type of HousingUnit: <br /> ❑Single Family Dwelling . Mobile Home ❑Other: <br /> #Employees in Unit: Date Unit First Built or Installed: <br /> Electrical Power Provided By: <br /> Gas Provided by: <br /> HOUSING UNIT INSPECTION <br /> Interior Checklist <br /> Unit has hot and cold running water. Comments <br /> Okay <br /> ❑Needs Re alr" <br /> Approved electrical power and gas fuel being supplied to Unit. 00kay <br /> EQ I <br /> Heater maintained in functioning and safe manner(No space/portable heaters). Needs Okaayy airy <br /> Doors and windows are accessible/operable to allow for safe exiting, El N eds ay air* <br /> ®Okay <br /> N?Le Re air" <br /> All rooms are clean and sanitary.No insect/rodent infestations present. 100kay <br /> All appliances(stove,water heaters,air conditioning units,heaters are N eds Repair <br /> ro erl vented strapped and are maintained in a safe,workin order. Okay <br /> All smoke and carbon monoxide detectors are present and tested to be shown El N eds Repair' <br /> in workingorder. okay <br /> ❑N eds Repair' <br /> All wiring in safe,working order(no splices,exposed wires,uncovered outlets). Okay <br /> ❑NasReair* <br /> Ali plumbing in safe,working order(no leaks,properly maintained), Okay <br /> El Re <br /> All counters,sinks,toilets,tubs,showers are working and in sanitary condition. N ads Okaayy air <br /> All floors,walls,callings are free from holes,are not sagging or buckling,have D N ads a air" <br /> no water leaks and are clean and in ood condition. y <br /> Exterior Checklist ❑Needs Repair" <br /> Roof is properly maintained with no holes,loose shingles,leaks,etc. [Okay Comments <br /> Exterior siding is maintained with no loose plaster,peeling <br /> ads ay air* <br /> P p g paint,holes,etc. Okay <br /> eds Re <br /> Stairways are safe with no rotting,deteriorating,or loose parts. E3 N6Okay air* <br /> ds Re <br /> Propane tank has barrier protection and"No Smoking'signage, El N Fe <br /> air• <br /> Needs Re air` <br /> The trash cans are sufficient in size,have lids and are picked up weekly. Okay <br /> The electrical panel is covered and protectedfrom tampering. ElN eds Re air' <br /> Okay <br /> The gas fuel con nectlon is as approved and safe. Needs Re Okay air' <br /> There are no insect or rodent Infestations. ❑Needs Re air, <br /> 4aukay <br /> The sewage system is functioning,with no surfacing wastewater or backup, Needs Re air" <br /> Okay <br /> "Needs Re air.Pleases 0 Needs Re air* <br /> ecif date re airs to be completed,An n..:-,Ing Permits required for repairs must be obtained and finaled. <br /> I certi that have inspected the above noted unit and that the Information provided t true and correct to the best of m knowled e. <br /> SIGNED: �� /` C <br /> GL } I <br /> DATE Tm E <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 WWW.Sjcehd.com <br />