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SAN JOAQUIN COUNTY <br /> - EN\�-_.ONMENTAL HEALTH DEPARTN'ItTqT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/eh <br /> koR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: FMA Inspection Date: L15 <br /> Address: 39 \,P v)tN jalayW � �/'lbGK�vN -- PE: 209- PR#: 2 S0094' <br /> Owner/Operator: )/J&g,,t� L49-0 Phone: yby_ AG 03 <br /> _IM 1 Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: SG #Units Inspected: fi 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 /> El 2 functioning sink/toileUbath; 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. Heatinq: 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 /> ❑ 5 Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> [_1 6. close fitting covers;Garbage receptacles unclean or in disrepair. <br /> F-17. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways,exits,or other <br /> publicly shared spaces. <br /> f 8. Pest Control: Infestation of insects, vermin or rodents. /jpff ulm_ ftt,4407Y <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?.X'Yes ❑ No Company Name: i'rri£ vF 111A,,9 / °T 41,444equency: 110,q,If <br /> Hotel/Motel Business License? ❑Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcemenUFire❑ County Code EnforcemenUFire❑ Other <br /> Rooms inspected: 1 2 3 3Y 3'L I Y 3 <br /> Comments: f r — Kars pir-1f4og 0W /11aF7 Attrj Afl4v7V. <br /> f 4- Vitir7L N7- 3Y- ✓+97/7X7" ' 7f -0E — vft7741' . FZ vo/L ytil, i& /)•1 <br /> F7,3 r t I V litm Er uXp rini+oH,vd .rrNK crOtI00/J 016TC whir 9C <br /> M nl5J 1 6 n7H 4- ffOWY 6177# -,V')f/f VP 040416 AMIMW /,7rzyL0/^4 10 <br /> 3Jt f' vOk GvvCA1,4 Pt'CuPb .Off- • I-VU A94 ter .ru \fY*Wy.fA4K 01407f tit"'Y t64. <br /> All violations in rooms not inspected must also be corrected. <br /> All s ecti s by t onmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental H S ecialist: Phone: <br /> l ` Page 1 of <br /> EHD 24-01 06-04-10 <br />