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rY, <br /> 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: cp­e'sr O'r it Inspection Date: <br /> Address: L03q N t�nA1./Lt ) <br /> Owner/Operator: FA-T 7 (' p,�s QftAI Phone: <br /> QkAnnual 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 /> ❑ 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- <br /> 2. functioning sink/toilet/bath; 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 <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. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack #I I ri",4 VV13-K4Ar�Qr Ifo <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate 1d <br /> protecti n from weather; Inadequate sewage or water facilities. Z smo <br /> Pest control Used? XYes ❑ No Company Name:-TVAM I Frequency: d <br /> Hotel/Motel Business License? Yes ❑ No Snn ' <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: <br /> Comments: <br /> wsnnGq ist4wz& alp o sf n .W177 <br /> u o c�DPs conaeA W Q <br /> U�Gw ±2 ML0MrP <br /> - <br /> mrn a <br /> All violations rooms not inspected must also be corrected. <br /> All re= ' n Environmental Health Department will be billed at the current hourly rate. <br /> Receive Title: 17 <br /> q, <br /> Environmental ea th Specia is . Phone: �c <br /> �j�1 '`�—}v Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />