Laserfiche WebLink
Po�IN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2: .2 <br /> y. I 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <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: C GN \� v P > PR#: <br /> LOCATION: MAP DESIGNATION: <br /> HOUSING UNIT INFORMATION <br /> Address or identification number of unit: c q C I d , Date of Inspection: _ — <br /> Type of Housing Unit: Ingle Family Dwelling ❑ Mobile Home ❑ Other: <br /> #Etnployees in Unit: Date Unit First Built or Installed: <br /> Electrical Ppwer Provided By: (Q Gas Provided by: <br /> HOUSING UNIT INSPECTION <br /> Interior Checklist Comments <br /> Unit has hot and cold running water, kay <br /> ❑ Needs a air* <br /> Approved electrical power and gas fuel being supplied to Unit. []Okay <br /> ElNeeds Re air* <br /> Heater maintained in functioning and safe manner(No space/portable heaters). L90kay <br /> ❑ Needs a air* <br /> Doors and windows are accessible/operable to allow for safe exiting, kay <br /> ❑Need Re air* <br /> All rooms are clean and sanitary.No insect/rodent infestations present. LjOkay <br /> ❑Needs a air* <br /> All appliances(stove,water heaters,air conditioning units,heaters)are properly vented, kay <br /> strapped and are maintained in a safe,working order, ❑Need Repair* <br /> All smoke and carbon monoxide detectors are present and tested to be shown in working a0kay <br /> order. ❑Need Repair* <br /> All wiring in safe,working order(no splices,exposed wires,uncovered outlets). Okay <br /> ❑Need a air' <br /> All plumbing in safe,working order(no leaks,properly maintained), [20kay <br /> ❑ Nee Repair* <br /> All counters,sinks,toilets,tubs,showers are working and in sanitary condition. Okay <br /> ❑Need tie air' <br /> All floors,walls,ceilings are free from holes,are not sagging or buckling,have no water Okay <br /> leaks and are clean and in good condition. ❑ Needs Repair* <br /> Exterior Checklist Comments <br /> Roof is properly maintained with no holes,loose shingles,leaks,etc. k ElNeed e air* <br /> Exterior siding is maintained with no loose plaster,peeling paint,holes,etc. E]Dkay <br /> ❑ Needs' eair* <br /> Stairways are safe with no rotting,deteriorating,or loose parts. k y <br /> ElNee Re air* <br /> Propane tank has barrier protection and"No Smoking"signage. Okay <br /> ❑Nee Re air* <br /> The trash cans are sufficient in size,have lids and are picked up weekly. Okay <br /> ❑ Nee 'Repair* <br /> The electrical panel is covered and protected from tampering. okay <br /> ❑Nee Re air* <br /> The gas fuel connection is as approved and safe. ElNee Os Re air* <br /> There are no insect or rodent infestations. Oka <br /> ElNeed a air* <br /> The sewage system is functioning,with no surfacing wastewater or backup. kay <br /> E3 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 BY: L <br /> NAME DATE TITLE <br /> EH 27-XX 9/20/2013 v' Dairy Farm Employee Housing <br />