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ota�. ln. SAN JOAQUIN COUNTY <br /> Ei . RONMENTAL HEALTH DEPART = NT <br /> 1868 East Hazelton Avenue, Stockton , CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: flwlyaar /yO Inspection Date: pL <br /> Address: %SS �' f DO/Cf�nO CrTe PE: 2 y/& PR#: O Z y ot)j e; <br /> Owner/Operator: Pil ?eL Phone: <br /> Annual Inspection ❑ Complaint Inspection [] Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: ' f # Units Inspected: t0 1 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- 14 C4W&Y <br /> 2 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 /> ❑ 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 /> ❑ s 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? EKYes ❑ No Company Name: Frequency: t7N6C A HOYTH <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected: 1 , .5 j5A Z I 2i0 <br /> Comments: fille 5xnj / bd,(fttW - eft p/ g / y <br /> `1 - IC MM170 IM11 ' LPHOKE Xlt cE %PA TXI kt OV47 ' C012,464169 <br /> Yl - GfM,/�7 N' �/ ' .6 /�G�+3G�D /rU ✓►70A',E pt;t•�1o/t- <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 hourly rate. <br /> Received By: Title: <br /> 0 <br /> Environmental Health SpecialPhone: � / �� 917y � 9 , <br /> (0 Pa e 1 of <br /> EHD 24-01 4-30-12 HOTEL / MOTEL OIR <br />