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aq�lrr. SAN JOAQUIN COUNTY <br /> �R ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'a <br /> ki 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> t"; Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.or /q ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: oki /( Win <br /> r^ {�► �S� a Inspection Date: i F1 (fol go <br /> Address: 50 L+5 t� �S Lr� �-{7(A St _A 15 5 PE:i1,rrp4 PR#1:V`ECJ' I$?)b NO <br /> Owner/Operator: T 1I.��. y-� r Phone: //nrt _/fit ��I��,. <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection <br /> `t I <br /> #Units in Facility: 3 #Units Inspected: l 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 /> ❑ 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 nom„ 10 ro tV tl I e_('d'C)G16 h0i- <br /> 2 funct'onin sin oile ath; Lack of hot water. Floors: Not clean, properly covered or in f It l&H.. <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 /> ❑ <br /> s. <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,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 /> Bedding: Mattress/linens infested with lice,bedbugs,or other insects;Not free from filth or <br /> F-1 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. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous al Gr1 _VVir) <br /> Other Substandard or Unsafe Conditions: lectric tructural, r plumbing azards; L — 00-f WO►'Kl ln� <br /> 10. of o Wade uate smoke detectors r fire extin uls ers; Inadequate lighting; Inad 2 <br /> protection fr m weather; Inadequate sewage or water facilities. y g -(,� j � � � 'C'Int � <br /> Pest control Used? Ayes [:] No Company Name: Frequency: <br /> Hotel/Motel Business License? W, <br /> es ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: i ®IO 2) 3� 2S <br /> Comments: D <br /> ►,mss a , <br /> m6j)ntairl nc wvK& deAfqws iifao room. . <br /> c ' Coritydi CILMI i7d& ULWSe, trlorjep, <br /> el ICAoDO <br /> j All violations in ro ms not inspected must also be corrected. te. l�RV <br /> All re-inspections b the Environmental Health Department will be billed at the Curr ourl a <br /> Received By: _ _ Title: �j ^ ' <br /> Environmental Healtd Specialist: - Phone: 2�1 ;1bQ)';�_ + Page 1 of <br /> EHD 24-01 4-30-12 V rl -� ►1f� HOTELIMOTEL OR <br />