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>-gYkISAN JOAQUIN COUNTY <br /> x4•: .Ef .o <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.or /q ehd <br /> a <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: J N w, � � Inspection Date. 2 1 al <br /> Address: �.S S. 1,V M tiv� n.r,�, _1 S PE:2 PR#:o7 1O II2- <br /> Owner/O era or: TOOW, 1 I'��C�t Phone: 9348- 01G� <br /> l,A �- <br /> nnual Inspection ❑ Complaint Insp ction ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: Units Inspected: Reinspection On or About: <br /> Th terns 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. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in 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 /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> ❑ 3' 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 /> s. foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ s 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 <br /> ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protecton f m weather: Inadequate sewage or water facilities. <br /> Pest control Used? Wyes ❑ No Company Name:bl Frequency: <br /> Hotel/Motel Busine License? Yes ❑ No <br /> Multi-Jurisdictional Violations to KP Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: g f <br /> Comments; <br /> NO, 014�AN 11W <br /> Y 116 Y <br /> i <br /> All violations in rooms not inspected must also be corrected. <br /> All refinseections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: t _ Title: � <br /> C � <br /> Environmenta ealthvS_pe_c`ialist: Phone: Page 1 of <br /> Lq21V <br /> EHD 24-01 4-30-12 V HOTEUMOTEL OR <br />