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aq�r►r. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> `hi.- HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 10WAr-d / © Inspection Date: 4 9 <br /> Address: &3 At <br /> C-e�J'I�l� ,r^yr, �'��7 P Q PR#: D/17 <br /> Owner/Operator: Argy ��&4 _ti �!z t Phone: <br /> 9 <br /> nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: 8'0 1 #Units inspected: / f! Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> ❑ 2. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in <br /> good repair, Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ 3 Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> working condition; Lack of adequate heat(Standard:70°F at 3 feet from floor). <br /> Drinking Utensils& Ice Buckets: Not protected from contamination; Lack of or improper <br /> ❑ 4. washing&sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> ❑ <br /> Beddin : Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or 5" foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles;Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> 7' Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> publicly shared spaces. <br /> ❑ 8. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack <br /> ❑ 10. Of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather: Inadequate sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name: 0 <br /> C�;.� Frequency: No <br /> Hotel/Motel Business License? S.Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: /0_5r jp6 306 <br /> Comments; <br /> c_ <br /> 6 �- - <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current houriz rate. <br /> Received By: Title: /�(Al v t <br /> Environmental Health Specialist: Phone: V �V� <br /> Page 1 of <br /> EHD 24-01 4-30-12 HOTEVMOTEL OR <br />