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�tckUVN, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ' Y. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www,s'gov.org/ehO <br /> 9�OFOR`' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: tX116A6 Afi 44 ta- Inspection Date: 05 <br /> Address: 15l&S CL_ 120"VCO U^77 T' j'?C(1KtD+j - PE: ?�`//b PR#: (hV2,yovlb <br /> Owner/Operator: j+frfH1) <br /> K#y6r7 PCZ Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: #Units Inspected: 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 /> ❑ I 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 impropernle <br /> ance; Broken or non- <br /> 2. <br /> on- <br /> Yy 2 functioning sink/toilet/bath; Lack of hot water. Floors;,Nproperly covered or in <br /> 1, good repair.Walls&Ceilings:Walls/ceil ngs need Qf c eani- or repair: Holes,water <br /> damage,peeling or deteriorating paint;Dar(tpness 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 /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> F] 6' close fitting covers; Garbage receptacles unclean or in disrepair. <br /> Public Areas: Unsafe or unsanitary conditions in kitchen, hallway stairways.dxits,or other <br /> 7' 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? ffYes ❑ No Company Name: MW1-• Frequency: /jvNn <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: <br /> Comments: <br /> og— RC-�i,f 0- G{•l CSA-PM+xw <br /> /I-- 131?WAP117n J440 <br /> All violations in rooms not inspected must also be corrected. <br /> All/e�inspqctionsathe Environmental Health Department will be billed at the current hourly rate. <br /> Received By: - Title: — <br /> Environmental Fre Specialist: Phone: Page 1 of <br /> EHD 24-01 06-04-10 HOTEL/MOTEL OR <br />