COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

S A N 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: (" 1-41A "� PR#: LOCATION:<; 6 j1)d11)ijjWr [%a eA MAP DESIGNATION: HOUSING UNIT INFORMATION Address or identification number of unit: t aj .1� b,,pate of Inspection: Type of Housing Unit: 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 Checklist Comments Unit has hot and cold running water. Okay ❑Needs Repair* Approved electrical power and gas fuel being supplied to Unit. Needs Eleeds Re air* Heater maintained in functioning and safe manner(No space/portable heaters). okay ❑Needs Re air* Doors and windows are accessible/operable to allow for safe exiting. ®Okay ❑Needs Re al All rooms are clean and sanitary.No Insect/rodent infestations present. 2rOkay All appliances(stove,water heaters,air conditioning units,heaters)are ❑Need L20ka a air* properly vented,strapped and are maintained in a safe,working order. ❑Needs Repair* All smoke and carbon monoxide detectors are present and tested to be shown [ Okay in working order. ❑Needs Repair* All wiring In safe,working order(no splices,exposed wires,uncovered outlets). kay Needs Repair*_ All plumbing In safe,working order(no leaks,properly maintained). jef0kay ❑Needs Re air* All counters,sinks,toilets,tubs,showers are working and in sanitary condition. okay All floors,walls,ceilings are free from holes,are not sagging or buckling,have ❑ 8eds a air* no water leaks and are clean and in good condition. J key Exterior Checklist ❑Needs Repair' Comments Roof is properly maintained with no holes,loose shingles,leaks,etc. BOkay ❑Needs Re air* Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. I Okay Needs Repair' Stairways are safe with no rotting,deteriorating,or loose parts, WOkay ❑Needs Repair* Propane tank has barrier protection and'No Smoking"signage. jejOkay ❑ eeds Re air* 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. F]Okay Needs Re air* The gas fuel connection Is as approved and safe. (20kay — Needs Repair* There are no insect or rodent infestations. C-JOkay ❑Needs Re air* The sewage system Is functioning,with no surfacing wastewater or backup, 120kay ❑Needs Re air* *Needs Repair.Pleases eci date re airs to 6e com leted.Anv Building Permits required for repairs must be obtained and finaled. certify that I have inspected the above noted unit and that the information provided is true nd correct to the best of my knowledge. SIGNED: ' r� I n" �} DATE TITLE 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com