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SAN JOAQUIN COUNTY <br /> .co <br /> ENV06NMENTAL HEALTH DEPARTMETC1` <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: By,00rT Inspection Date: <br /> 6. such r /2 1i /y <br /> Address: ,3y�3 W 071mr rm Lthit V"10('V_�jl61 PE:�y04 PR#Mo2gOW9 <br /> Owner/Operator: �,I Q-IN VVUAx/k I IV(I` M�#6 Phone: <br /> MrAnnual Inspection ❑ Complaint Inspection Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: # Units Inspected: f Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summuy of Violations and Code References. 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 I'mpQper maintenance; Broken or non- <br /> 2 functioning sink/toilet/bath; Lack of hot water,q loo of clean, properly covered or in <br /> 'X good repair.Walls&Ceilings: a s/ceilin n 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 /> ❑ 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 Gage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> ,dd6e fitting covers?Garbage receptacles unclean or in disrepair. 61W W OhnvN S 1 <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 -3t 3 Ci 3 V-33�y <br /> 10. of or inadequate e o e e fire extinguishers; Inadequate lighting; Inadequate <br /> protection from west er; na equate sewage or water facilities. I 3Yoj vll' Z,731IY7— <br /> Pest control Used? Yes ❑ No Company Name: ,8/LK 11,/ fC� Frequency: X 110AIM Iex A IV <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: /// 5�O 3 1W 5-013U '/ 3VY. �7 2y - 233 YZ /Y/. <br /> Comments:j//- 9#7MWn, t1C-rlr W IW 1/T It CQVCYZ <br /> 'or7V /wOW JN 7011 or< R-/c vN rr; ft/6. "vC-X. 61W.<CW <br /> 33 0- (Are is vino GovaL jWkr r jj,6 bK- G me vvogz_ Alc zw1r <br /> M/1- rOLf iL l-f cccl ovi Thi" CX/�Zf/Alb flOM1 "14, ;r fM <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: ,I J12 ,, Title: <br /> Environmental Health Specialist: Phone: Page 1 of 2 <br /> EHD 24-01 4-30-12 I I tJ HOTEUMOTEL OR <br />