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0.q:►� SAN JOAQUIN COUNTY <br />2 ��~ • ` ENVIRONMENTAL HEALTH DEPARTMENT <br />ki 10 <br />1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: / m i r t <br />, / �r�+1 <br />Inspection Date: 3/y/ q <br />I <br />ca <br />Address: , 9. <br />>, �l t Jf1 �OGX.'�.'071 (/I, 7S ,7 <br />PE: 2Yl <br />PR#: oS 2 ZS Z <br />Owner/Operator: . .X <br />Phone: <br />XAnnuW Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: <br /># Units Inspected: � <br />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. <br />Room(s): <br />❑ <br />1' <br />Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />garbage, combustible items or similar materials. <br />2. <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 />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 />C,9 D`0 tem <br />�� Y <br />❑ <br />3 <br />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 />❑ <br />4. <br />Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />❑ <br />5. <br />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 />❑ <br />s <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />close fitting covers; Garbage receptacles unclean or in disrepair. <br />F-1 <br />�' <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />publicly shared spaces. <br />❑ <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />10. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lackg <br />of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br />protection from weather; Inadequate sewage or water facilities. <br />S� G S S Aoke �-t edial j <br />fo k Ali :oo ny <br />Pest control Used? WYes ❑ No Company Name: Te in7 71 ix Frequency: -fv1,✓ j G 2 (;� v ,f <br />Hotel/Motel Business License? 5ees ❑ No <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: CB <br />Comments: C o 11 4 �2 c o 'V S n lC� Q by�T71 <br />Lc c a: -Nr -e cm;t 46- L,) oPC <br />All violations in rooms not inspected must also be corrected. <br />All re -ins ections by the Environmental Health Department will be billed at the current hourIX rate. <br />Received By:\� <br />Title: <br />Environmental Health Specialist: i Chi one: C702 <br />u brS— 3 � j S <br />Page 1 of <br />EHD 24-01 4-30-12 S , c 3>r—k i HOTEUMOTEL OR <br />