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<br />NCDA&CS, VETERINARY DIVISION
<br />1030 MAIL SERVICE CENTER, RALEIGH, NC 27699-1030
<br />PHONE: 919/733-7601, FAX: 919/733'2277
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<br />INDOOR 0
<br />OUTDOOR 0
<br />BOTH 0
<br />
<br />Type of Inspection
<br />~-~~.."P .
<br />Annual 0
<br />Follow-Up
<br />(Prev. Inspection Date)
<br />Complaint 0
<br />Courtesy 9(
<br />Random 0
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<br />GPSCoordioates- N: rn.[[]II] W: CD.[[]II]
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<br />QBSPNumber- rn- [[I]-CD-rn-O
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<br />/l .
<br />"',JJUSINESS NAME: (~'r f j . :': (( j >!/ii/:';:;C '..'//c"Zn:- LICENSE #:
<br />':OWNER: ./ ;,;'/-'. if' .1".//;1.'.,-" . '/, /.~ /j./ . I;'
<br />.'ADDRESS:,:?. /'. .7'5( / /{IE/ /.'[/,c.'t'.,,"/ /
<br />,'TELEPHONE: (;1:,4 ) ~?) (/ - ;:;Ur 1f VMO COUNTY
<br />OO'rVPEFACILlTY: Animal Shelter J;\{ Boarding Kennel 0 Dealer 0 Pet S ?p
<br />'j':,.N!lmber of Primary Enclosures 9,:;- Animals Present: Dogs ? 0
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<br />ANIMAL WELFARE INSPECTION
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<br />(j",C.-A"
<br />
<br />ox' !f,'~,:;::) <
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<br />;' f,4/;';j~)A:'Jj.:>>-/'--:_
<br />o Public A~c7~. .'? .
<br />Cats 5,., "'" 7;"
<br />I
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<br />
<br />
<br />.y__>o..'
<br />
<br />~t]WC'I'URE
<br />" ousio . Facilities
<br />'l Structure & Repair
<br />. . Ventilation & Temp.
<br />", Lighting
<br />,. .)Ceiiing, Wall, Floors
<br />",O.S). Storage
<br />"~'_.
<br />:N';'6.,Water Drainage
<br />
<br />SANITATION
<br />II. Waste Disposal
<br />,- . Odor
<br />3. Ceiling, Wall, Floors
<br />Ac 14. Primary Enclosures
<br />.p(IS. Equipment & Supplies
<br />A:-16. Washrooms, Sinks, Basins
<br />( 0 17. Insect/V ermin Control
<br />\':ifl'8. Building & Grounds
<br />HUSBANDRY
<br />)5.19. Adequate Feed/Water
<br /><.E..1D. Food Storage
<br />.0;'21. Personnel
<br />1'\'22. Animals' Appearance
<br />
<br />
<br />'.\'->"
<br />
<br />i\~':pHl11arv Enclosures
<br />';ff)f,.7.. Structure & Repair
<br />;~8. Space
<br />:':~9. Ventilation & Temp.
<br />II;:!?' Adequate Shelter
<br />"--.:';t".,>. -
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<br />;'-/ /'
<br />t' -:" /O::::c:'.....c: -~, '<I--~;A;. -.' >,.... -'7//"':.- /?';-- /';:'.,"-;'/'f,. <';'<: ,;: ;/>, 1 >~: [J ,,-,j~~'~-
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<br />SPECIAL ITEMS
<br />~cords
<br />. 23. Description of Animals.
<br />4<\'24. RecordsNet Treatment
<br />~;~t.3riginlDisposition
<br />LJ'r"ignature (boarding kennel)
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<br />Tran ortation
<br />~are in Transit Discussed
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<br />Veterinarv Care
<br />(:O"'21D Isolation Facility
<br />-o-WAo Signs 01 Illness/
<br />Treated
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<br />
<br />'_<0-" "1/.7\,(/
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<br />4.,' "r-.,,-;;,'i ,,'/~")~/J:'::' 7c.J ~~.Aj' -j'/--:" /'.;
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<br />'::r ,'. <;'((/4; t:. &;'/" /l~;..)/ ..;r;rlj t- --k'~5-
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<br />/>-A>/)/}.f)'j r~/'6'~)"'/~/G:-:f'--.; cF'" C-(I_.~::-N/{)f:./,~/!:."....-4
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<br /><<6 APPROVED
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<br />/ /, / Jr. r;
<br />(';' .,d V' '-'h'
<br />I' ,
<br />
<br />o DISAPPROVED
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<br />Date:
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<br />%Veterinarian:
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<br />......> ~.<-A~'S:.._,.\//J~,~c;,:,,__.~.( J
<br />. '.' ___/ .. In~pect6r's Signature
<br />:~}~_AW~2 ij
<br />';;'?Re~.2/05 White= Office
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<br />Telephone: (---.J
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<br />
<br />Time:
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<br />II: 'iLl
<br />,
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<br />(~~.~ . - .{,-
<br />Owner/Authorized Agent's Signature
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<br />Canal)"'" Inspector
<br />G-S
<br />
<br />Pink= Owner
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