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oaqUly 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 /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C Uife . G1,261 Inspection Date: - i <br /> q J 1 [-� <br /> Address: 33 A Cam. PE: PR#: <br /> Owner/Operator: /A -M D RAHMA N Phone: <br /> Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: to I #Units Inspected: IS 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- 10 .3CR 3 /2 <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in i <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 /> ❑ 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. �npt(Zonw� <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? N Yes ❑ No Company Name: Lp Frequency: LR_ <br /> Hotel/Motel Business License? Kyes ❑ No I () 3 Zb <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 'kw 3 2 Z , 3 >> Z 3 232. 22+,2U i n i 2Z11 129 lW <br /> Comments: on p,tEx.l?yt,"1 ,� s t' iY-110 4 iCVAj <br /> 2+ - t 33S r <br /> 00 <br /> SCP&�M t, 73 <br /> ft,r M6 <br /> All violations in rooms not inspect d must also be,corrected. tm rK L1 �� 6 S r 044�= i . <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly ra�e. <br /> Received By: //'` � — Title: r'4/y'4/eI< <br /> Environmental Health Specialist: i Phone: 6 1,6_ P? Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />