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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4' 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> '•' :•J Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov orglehd <br /> �4� FORa off HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Iwo IjO1JF INtJ Inspection Date: 0� <br /> Addess: l� W "x/10 -� �p�K7p�/ PE: Na P <br /> rR#:flog voy-�- <br /> Owner/Operator: I D I K r rtrT -L Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: 3 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 /> 1' garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- <br /> 2. <br /> on- <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 /> ❑ <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 /> ❑ a. 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 <br /> 11TO <br /> 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:/'4e-7EK Or—IT n,W Frequency: 110A11WO <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; /O p 10 11 105; IN 103 OZ 101 // 1/1'.1 Z'V 4 LI <br /> Comments; rontioij. 196,6W <br /> l�10, - V67-'4 r- Fyl is, o vwXKIN6 M�rrE 44*6r gourp <br /> V6-tfi RN I1 NOT WXKJ .& <br /> IF 107 CAWT It 64OV60 42MV AWYnir-P MM 111/01- COW-IA14 <br /> r/Z - V64 -( ► �p vc�41- FVj rust 6 �- 0196#- <br /> All violations in rooms not inspected must also be corrected. "17Q4 <br /> All re-i e i ns the Environmental Health Department will be billed at the current hour) rate. M <br /> Received By: Title: <br /> Environmental Healt Phone: l'� <br /> i ii' Page 1 of <br /> EHD 24-01 4-30-12 HOTELIMOTEL OR <br /> J � <br />