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Aq� y SAN JOAQUIN COUNTY <br /> .o ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> "••;dip'' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: )'1 IT67 tio"IF WO .rifft Inspection Date: 02 2 -3 l S <br /> Address: Z30S �P C1- VO2ROt2 � TV6000 ls7vk PE: � � PR#: r1W 9D 3(o2 <br /> Owner/Operator: KftJeH PVMff� 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 /> ?ter 1 Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, f 66vk6� <br /> A garbage, combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- 6CL�76 f <br /> 2 functioning sink/toilet/bath; Lacko hot water. Floors: Not clean, properly covered or in <br /> good repair. Walls & Ceilings: al Slings in need of cleaning or repair: ole 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 /> ❑ e 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? XYes ❑ No Company Name: (�A M Of Frequency: 0,46e HON <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: y s 10 11 <br /> Comments: <br /> 3- !. I/J ✓Y/ow1S1 Nteg7V 6f= C6 7WCO <br /> — (LC°t.HY.E 6 U t8 1�1 6H'rH/fOON <br /> s - ✓flut>.1'f . 6 "C6 #N"CY7 SINK Pw4611jZ r,C-?h _f CIWC=r hurlb W vim <br /> - 0& Jlr4G l/J 601. 4 & 1730VC fle 5 7Nn/6 . SPC 7� t�t faa. nrch`. twe <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 /> Environmental HeNth Specialist: Phone: (� — ffv1 Page 1 of l <br /> EHD 24-01 4-30-12 7 HOTELIMOTEL OR <br />