Laserfiche WebLink
SAN JOAQUIN Environmental H <br /> COUNTY ealth 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: ) O <br /> LOCATION: PR#: <br /> HOUSING UNIT INFORMATION �4 MAP DESIGNATION: <br /> Address or identification number of unit: j <br /> � f Inspection: _-�5'a <br /> Type of Housing Unit: ❑ Single Family Dwelling KMobile Home ❑Other: <br /> #Employees in Unit: Date Unit First Built or Installed: --- --------- <br /> Electrical Power Provided By: � Gas Provided by: <br /> HOUSING UNIT INSPECTION 0 Q <br /> Interior Checklist <br /> Unit has hot and cold running water. Okay Comments <br /> ❑Needs Repair* <br /> Approved electrical power and gas fuel being supplied to Unit. .40kay <br /> ❑Needs Re air' <br /> Heater maintained in functioning and safe manner(No space/portable heaters). kay <br /> ❑Needs Re air' <br /> Doors and windows are accessible/operable to allow for safe exiting. Okay _ <br /> ❑Needs Re air' <br /> All rooms are dean and sanitary.No insect/rodent infestations present. Okay <br /> All appWices(stove,water heaters,air cart0ming units,heaters are El Needs air' <br /> r veiled,strapped and are maintained in safe,workingor E]Oka <br /> der, <br /> ❑Needs <br /> Repair* <br /> Al smoke and carbon monoxide detectors are present and tested to be shown kay - <br /> in order. ❑Needs Repair' <br /> All wiring in safe,working order(no splices,exposed wires,uncovered outlets). Okay <br /> ❑Needs Re air' <br /> AB plumbing in safe,working order(no leaks,properly maintained). kay <br /> ❑Xy <br /> a air" <br /> All wunte-s,sinks,toilets,tubs,showers are working and in sanitary condition. — <br /> ❑ e air' <br /> Ali hoots,waEs,ceilings are free from holes,are not sagging or buckling,have okay <br /> no wee leaks and are clean and in good condition. ❑Needs Repair* <br /> Exterior Checklist <br /> Comments <br /> Roof is prop"maintained with no holes,loose shigles,leaks,etc. okay <br /> ❑Nees Repair* <br /> EXVft sift is maintained with no loose plaster,peeling paint,holes,etc, okay <br /> D Nee a air' <br /> Sb:�sresafe with no rotting,de'alioratinr�I crbcw parts. Okay <br /> ❑Need Repair* <br /> Propane tank has barrier protection and'No Smoking'signage. kay <br /> ❑Nee 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. ZOkay <br /> ❑Needs Repair* <br /> The gas fuel connection is as approved and safe. ❑Nee Okay air' <br /> There are no insect or rodent infestations. okay -- <br /> ❑Need Re air' <br /> The sewage system is functioning,with no surfacing wastewater or backup, kay -- <br /> ❑Needs Repair* <br /> `Needs Repair:Pleasespecify 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: <br /> DATE 02- TITLE <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />