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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 /> "'FOR�'� HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 A �1 kinT4 MGIi P- �nn -- Inspection Date: <br /> 1� Ul I ct {� ��7� 5! <br /> Address: i�-� l� . 'M ar/)rl i(I n 01 \Iv CK tur I� 14q PE:41i PR#: x440111 <br /> Owner/Operator: Phone: _ <br /> �tagon &\j 1 n 1 not - ZU 5,? -WicO <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: C ' #Units Inspected: 1fi 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- #37 /__A0` y_ <br /> 2' functioning sink/toileYbath;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 Flo( <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ <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 /> Bedding: 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. Cn <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: F M LAP)- Frequency: tY 0Tj j ( <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: �' .�.j,.( _ S, ,i�'�-� ` '� %'1 3 . -1 - <br /> Comments: J, <br /> 3 l <br /> (IA Q -'KrJR — <br /> All violations in rooms not inspected must also be corrected. <br /> A,Vre-i,pspections the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: 4 Title: -� <br /> Environme h Health Specialist: p - Phone: ���l_ Yol?) ILL Page 1 of <br /> EHD 24-01 4-30-12 C 1 vJ ��' HOTEUMOTEL OR <br />