1

1T;~~e~tionNew 0 _

Annual c __ 7=-+c-

Follow-Up Elq }It;(Prev. Inspection Date)Complaint 0 _

Courtesy 0. _

Random °

NCDA&CS, VETERINARY DIVISIONANIMAL WELFARE SECTION1030 MAIL SERVICE CENTER,

RALEIGH, NC 27699-1030PHONE: 919/715-711], FAX: 919/733-6431

iNDOOR t",OUTD061 G

BOTH 0

ANIMAL WELFARE INSPECTION

GPS Coordinates - N: .~.~ W:

Boarding Kenne~ Pet Shop 0 Public Auction 0

Number of Primary Enclosures --("-f~~-'----~,

Animals Present: Dogs __ ,---"-)__ Cats -----"----

Inspector: Mark "X" in each box, if adequate.Circle each item number, if inadequate.Use NA if not a Iicable

STRUCTURE SANITATION SPECIAL lITEMS

Housing Facilities,if I. Structure & RepairIf. 2. Ventilation & Temp.~ 3. Lighting~A. Ceiling, Wall, Floors~5. Storage:~~(6.Water Drainage

At 11.~12.'~/13.

t"14./1~f 15.·~··'16.r;

,PI7.

/~'18.

HUSBANDRY~J9. Adequate Feed/Water.f20. Food StorageAr 2 I. Personnel

.A.) IA·22. Ratio of 1.:10 p~rsonnel to. animals If>4 m pnmary

enclosure or common area1-~23. Animals' Appearance

Waste Disposal ~econl§Odor ~'24. Description of AnimalsCeiling, Wall, Floors ..J!,25. RecordslVet TreatmentPrimary Enclosures (jJT6") Origin/DispositionEquipment & Supplies I... V~ Signature (boarding kennel)Washrooms, Sinks, Basins -~'~ 28. Written permission fromInsect/Vermin Control owner for commingling

Building & Grounds (doggie daycare)

Primary Enclosures17. Structure & Repairj 8. Spacedr'9. Ventilation & Temp.:&r 1O. Adequate Shelter

Transportation),,129. Care in Transit Discussed

Vetelrinary Cane}(30. Isolation FacilityAi3l. No Signs of Illnessl

Treated

)YAPPROVED

. v v . ... -.Owner/ Authurized Agent's SignatureInspector's Signature

AW ..2Rev. 1/07 White= Office Canary= lnspector Pink= Owner

PAGE f OF ::::o.?

NCDA&CS, VETERINARY DIVISIONANIMAL WELFARE SECTION,1030 MAIL SERVICE CENTER,

RALEIGH, NC 27699-1030PHONE: 919/715-7111, FAX: 919/733-6431

ANIMAL WELFARE INSPECTION CONTINUATION PAGE

LICENSE #: IOk?\ (1TYPEFACILlTY: An~I,Shelt~r (Private/Public) 0 Boarding Kennel ;('Pet Shop 0 Public Auction 0

BUSINESS NAME: f~"lo,,}·1f- ,.v 1,;;'.) COWNER: ~~

fADDRESS: ~ -",,,- ,J.TELEPHONE: ( ) _, ./ (t:g; I~:-+.

y

Explanation.QfIna.<leq~acy(~irclediteD1~above) AndRe.commendation·ForCompIiance

Item Number Date Corrections'Must Be Completed

-l~~~+-------------~--------~----r-~'-~~-----------'------~--.--r--------------~

o ,v IClh,'"'I 0"'. i~ Clii.l.Je'''''L C>'hCJ ..;::;:~.ilC! ./4A;rf L.',..JDtAd hL CIU--.:;:,-4-~~-5f<'id.,

---,----------------------------------------------------------------------------------~

}(APPROVE;? o-€6N17ITfONALLY'APPROVED·

t 0(, ,£'f;..?i'.-,-~ /1 ,41 ./~~..-J,..t ., <_ ~,;-"'_

Owner/Authorized Agent's SignatureInspector's SignatureAW-2Rev, 1/07 Canary= Inspector Pink= OwnerWhile= Oflice

PAGE::.:?OF ~- -