Laserfiche WebLink
SAN J OAQ U I N Environmental Health Department <br /> COUNT Y---- <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: i-7, 4' ' i. LX-, PR#: <br /> LOCATION: I �• • b' (91?47 MAP DESIGNATION: <br /> HOUSING UNIT INFORMATION <br /> Address or identification number of unit: �.� r rR Date of Inspection: <br /> Type of Housing Unit: W,Single Family Dwelling ❑Mobile Home []Other: <br /> #Employees in Unit: / Date Unit First Built or Installed: <br /> Electrical Power Provided By: G, Gas Provided by: <br /> HOUSING UNIT INSPECTION <br /> Interior Checklist Comments <br /> Unit has hot and cold running water. (Okay <br /> Weeds Repair* <br /> Approved electrical power and gas fuel being supplied to Unit. [Okay <br /> ❑Needs Repair* <br /> Heater maintained in functioning and safe manner(No space/portable heaters). eeeOkay <br /> [I Needs Re air* <br /> Doors and windows are accessible/operable to allow for safe exiting. okay <br /> Eleeds Re air' <br /> All rooms are clean and sanitary.No insect/rodent infestations present, J20kay <br /> All appliances(stove,water heaters,air conditioning units,heaters ee <br /> are Needs ay air* <br /> properly vented strapped and are maintained in a safe,workingorder. El Needs kRepair* <br /> All smoke and carbon monoxide detectors are present and tested to be shown L7okay <br /> in workingorder. ❑Needs Repair' <br /> All wiring in safe,working order(no splices,exposed wires,uncovered outlets), 00kay <br /> ❑Needs Repair <br /> All plumbing in safe,working order(no leaks,properly maintained), []Okay <br /> ❑Needs Repair <br /> All counters,sinks,toilets,tubs,showers are working and in sanitary condition. j20kay <br /> All floors,walls,ceilings are free from holes,are not sagging or buckling,have ❑Needs <br /> keRepair* <br /> no water leaks and are clean and in good condition. y <br /> ❑Needs Repair* <br /> Exterior Checklist <br /> Comments <br /> Roof is properly maintained with no holes,loose shingles,leaks,etc. a0kay <br /> ❑Needs Re air' <br /> Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. ]Okay <br /> ❑Needs Re air" <br /> Stairways are safe with no rotling,deteriorating,or loose parts. ay <br /> ❑Needs Repair* <br /> Propane tank has barrier protection and"No Smoking"signage. WOkay <br /> [3 Needs Re air <br /> The trash cans are sufficient In size,have lids and are picked up weekly. Okay <br /> Ej Needs Repair*. <br /> The electrical panel is covered and protected from tampering. P-Okay <br /> EI 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 Re air* <br /> The sewage system is functioning,with no surfacing wastewater or backup. ❑Okay <br /> I:❑Needs Re air" <br /> *Needs Repair:Please specify date repairs to be completed..Any Building Permits required for repairs must be obtained and finaled. <br /> I certify t t I have Inspected the above noted unit and that the information provided Is true and correct tothe best of m knowledge. <br /> SIGNED: <br /> DATE ME <br /> 1868 E. Hazelton Avenue Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />