Type of InspectionNew 0----Annual 0 ---:-::=-----_=_Follow-Up I~ 1:30 lLD(Prev. Inspection Date)Complaint D~ __Courtesy D~ __

Random 0

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

RALEIGH, NC 27699-1030PHONE: 9191715-7111, FAX: 9191733-6431

INDOOR 0

OUTDOOR 0

BOTH X

ANIMAL WELFARE INSPECTION

GPSCoordinates- N: ~.~ W:

Pet Shop 0 Public Auction 0

S2) K-CINumber of Primary Enclosures ~ I hi.

STRUCTURE

Housin Facilities1. Structure & Repair2. Ventilation & Temp.13. Lighting

~ 4. Ceiling, Wall, Floors>tr 5. Storage)f 6. Water Drainage

ar EnclosuresStructure & RepairSpace

jtI9. Ventilation & Temp.~ 10. Adequate Shelter

Animals Present: Dogs 39 7Cats ~---'-~---

Inspector: Mark "X~'in each box, if adequate.Circle each item number, if inadequate.Use NA if-not applicable .....

SANITATION SPECIAL ITEMS

j(11. Waste Disposal Records"}s. 12. Odor »24. Description of Animals

~

. 13.. Ceiling, Wall, Floors )125. RecordslVet Treatmento 14 Primary Enclosures )(26. OriginlDisposition

15. Equipment & Supplies JJII~;,6- 27. Signature (boarding kennel))f16. Washrooms, Sinks, Basins ~ 28. Written permission from~ 17. InsectlVermin Control owner for commingling~18. Building & Grounds (doggie daycare)

HUSBANDRYJf 19. Adequate Feed/Water.;\120. Food StorageA'f 21. Personnel

i-J/,A22. Ratio of 1:10 personnel to. animals if>4 in primary

enclosure or common area}tf23. Animals' Appearance

Transportation):f29. Care in Transit Discussed

Veterinary Care;!1"30. Isolation Facilityif'31. No Signs of Illness/

Treated

o APPROVED Ei"CO~QITIO~ A..bLY ,A.••PP:ROYED jDISAPPRO,VED

~~

Date:~b3j( I Time~ .'{}o?o,

J '~tu /vlaftfU

AW-2Rev. 1/07

Inspector's Signature

Pink= OwnerWhite= Office Canary= Inspector

PAGE .L: OF 01

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

RALEIGH, NC 27699-1030PHONE: 9191715-7111, FAX: 9191733-6431

ANIMAL WELFARE INSPECTION CONTINUTATION PAGE

LICENSE #: g-~TYPE FACILITY: Animal Shelter Boarding Kennel 0 Pet Shop 0BUSINESSNAME:~~/~~~tL~~~~~~ _OWNER: -rADDRESS: ~~. _TELEPHONE: () ~ _

?'

Public Auction 0

Item Number Explanation oflnadequacy (circled items above) And Date CorrectionsRecommendation For Compliance Must Be Completed

d{ uJc:'e.' C~J/ow'-v ;J-l-.:v ,..,....,JEJ-/:3oI10I'-;;;J rlnM i- ,n'1~£r;f'7J ., W,,'Li Yo cle fC!rYn ',?•..--Vk O'~Dtr(1)g, ~e.- on -+t.~ C; exDerrnC""faJ/

()vyls' c'~~-.o,. i::z.. / ~f' IIv --fJ"L. I"Y?" fo..l ~ yo_+~ ;iya/V/ C' O'/(!"j it/Uk. herr, :n"i ..failedCYnd y~ K~nn~11 c.VL !::x:uLk /h 01<l.C'J.- --' /YI a.n r..-. f' p->c d-- S-fa..-fed V/.,~ Uk.t-(,. .' of~C ...i ,

·t-Ov ~t,"\ /i19 f)" ,/tVn b<l:.anw "\f~ us..~c' "';-k kihnd'J" .-rf:; L. 1-1 i /m.;: .~ (..J: ;1 be -.J

C Alj~d ~ d Q.p.() r{),J,ci hA-'c~ v-i.... U5h:':-J

OJ--£-

1- .s~G.1 010- Ch.J"'+ 'fL ru«: COt-X?/n-!;;.'~~ {'?Jolt ';J----L Kenn.h ~, k. i'h Pio.o-..'3" p~'''''rj -y-L bi IT* J.' 0 -+u: dvc-I'" (l(')(fiv nSl19 Ch «1- ~h CJ.p jC'c..nhJ'g,4- 1Y'lG-J<.•... soi« c-i j <;:·UIIO""f-/I-1 .••. rlV('.~ c..V-e- ii' ~d r~-Y,·'7e b j- LJI'U" ..., I~ d.?o I I Fc:;;> G,.1n IS) ,.s "'I-L ('t O~"VIJJ •,l'I'Jj·, d~ C~'r'1!cci o ao» b..., Robe 1--'1 (Y)O'L.IJr!'

81ad., •..C'o.1hCJ.ir,\JC\/h...--~·r7<!:v v;;-- c.:n-.rJK~ SUI'<J'l. St-.J-I,-. I

.suf)"" •.••ViPt' Y- •...J.,J

0N~~ ;f(r'''YlS G.c!dfl.'>.1fccf S;l-td- I~J30 Ii'"1- AJo doc't C-VL, br·,-", hr,,'(J ,rI W ..~t,c f'<f orl)~ ",-f_ .,sLJJ.._ ~-rt,,- .-

R .- .fti I cia::." Aar/ c.dd.i"';;L. .fO.u-l +- ,,\,..-r-;, I ...Jdd~. I

l3- .A-il c1~'3. T' Ns c...P-Pu.v.A C':'J',..,.(J,.. •.~c. ••hlL. (/Jfft-crDtd)\hdn.L. ,- I

".-.L.-I-l!rn,SJ ..-,-- ,A-c-lc1 r.; f, l :I L~

7) All fh'~.__ "t..J: ;n~'I- dO(9t-<::;: "- COun'V-" rYla/",'V 0../'",-0.- ,''1 otJcu-. e:I2- ~,,1S,c...-

rico .-~ Ykd H"eci ~i'rS _

i4-) ~n/+o*Vn ,,0 SicAf(,d ·.{:1cor-s - 01",)"'+',1'1 11"- -f.o J!@~ WC1;- k'; i-t Oh K<?<-pt't4,Vk bf!f/-c.-n o·p "'H-.e 'J. -+JtJc..--'! ('ll~ •-.I .,J

----- II .,r: ,-L n~:;{' C; e)(' ce v i rncvJfJ Ke nr> ",,'<.9 rln die-'ll/III f-) -h.'n "- .J-in. ,'7"1<- to.J ii I be. hzC.U'Vd. -Q,•... ~ av'ln+'"-,, cia 'lV rLib.. '>-S OM ~/o I J II.

I --'

o APPROVED * DISAPPROVED

~J~Date: ----~~~~-------

Inspector's SignatureAW-2Rev. 1107 White= Office Canary= Inspector Pink= Owner

PAGEC¥ OF~