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uiy <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.s*gov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> r <br /> ame of Facility: �1��'� 140Mt Inspection Date: 000 <br /> �S <br /> ddress: I3,.S J j'V1Li-04 W1�' k-P7XXX/UPE:�y�� PR#:�L40V,/�wner/Operattor: Pf g 6jit Anxw Phone: <br /> ]p AnnualInspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: 9 g #Units Inspected: - j—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. J 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 non- <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in <br /> z. 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, lyg <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 /> ❑ i 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 <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: fU Frequency: 7 Py L <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: /4 9 / 12S I 1 S <br /> Comments: JyS'- W� r-UAA;Ait -r NOT iN pt p/lfi'1 ea- <br /> 11 - Ow 1 t,' T b yftve WL-ow <br /> /1' - ,(LG7°vf1 t 6 AVXCx4 "wf-j f7 x r*n& c 0 <br /> 'Y' 133 ' ►1191-c.w j wb,rT h v wow <br /> 91 <br /> AIv" atiem in ooms not inspected must also be corrected. <br /> All re- ec ' s b env' o ental Health Department will be billed at the current hourly rate. <br /> Received By: �/�,� Title: <br /> i <br /> Environmental Heh1tht <br /> ial st: 7 Phone: ��� Page 1 of <br /> EHD 24-01 4-30-12 <br /> HOTEL/MOTEL OR <br /> I <br />