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SAN JOAQUIN COUNTY <br /> El. RONMENTAL HEALTH DEPAR-T _NT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1107rr- Inspection Date: 0 or /y <br /> 1 r=�� . <br /> Address: :Ji UPJ :�'o t�v/4 Jam, J7vc. PE �J� PR#:OL yoogb <br /> Owner/Operator: ��U GSD 69057 f6wl/77 k/ly,srlN Edi C4 'sgzo Phone: i/b t/ <br /> F' ( Ann_ual 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 /> ❑ Room Cleanliness: Lack of cleanliness&sanitation; Accumulation of debris,trash, <br /> t garbage, combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in <br /> ❑ <br /> 2. <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 /> ❑ s 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 /> ❑ Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or <br /> 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 /> ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways, exits, or other <br /> publicly shared spaces. <br /> ❑ s. 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,o lumbin hazards; Lack 9"70/l.E'! /1 (,e79 1,16 <br /> ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate i ; Inadequate W16/ Fu)-ruji. <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? . Yes ❑ No Company Name: jl r Frequency: <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: 3) 1 S� <br /> Comments: <br /> * Z` -vnah4 r ll0 f,v-reldb. G#GX r#9r lc'0 lWi�16/rCv <br /> Ir U Mil GO' "OH6''r XW14 1. - p/UfflWtO <br /> t1Rf40Vh "AO Ne'( &11Xbcn 17,xv oa) -WtO1,6 TD/L-Cl t'6L 1, xe=77 <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: PI ��' Title: <br /> A1011 <br /> Environmental Health Specialist: Phone: _ 7 Page 1 of <br /> '7 <br /> EHD 24-01 4-30-12 i HOTEL/MOTEL OIR <br />