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Pr98 Health Department 18
om of An" core
Inspection of Date of Insp/Chg: 0 6 / 2 4 / 2 0 1 3 Cm,,,tF,,ility ID2018200006
Lodging Establishment status bod
e: A Old Facility ID
Community
[I]Non-transient Non -Community
Wager sample taken t*dar. inspection
Name Change
[Dransient Non -Community
91 Non-PublIc Water Supply
Des -inspectionH
2 No 2 Re
Verification of Closure
fater Systetm, [Ecommunity
[2]on-Site System
Evisit
[:]Status Change
ATJT im 9 A :102 1
Location Address, 1520 1 3TH AV DR S rz 1.
City: HICKORY states NC zip 28661
L OBEY, HALLS AND STAIRS ( 1808)
1 Ventilation clean and in good repair ........... ........................ ..............................
2, Lighting meets requirements ..........
3. Floors, walls and ceilings clean and in good
4. Furniture and accessories clean and in good repair__ .........................................
LAVATORIES, TOILETS, AND BATHS (.1809)
5. Sewage and other liquid waste disposed of by approved methods.,
6- Properly operating sewage systems ....................... .................... ............................
7, Fixtures clean and in good repair, provided in each room if required_ ...
S. Lavatory and vanity sanitized, testing method available and used .._ .... ...
9. Towels provided clean and in good repair, soap .... .................................................
10, Floors,walls and ceilings cleanable, clean and in good repair,.,
WATERSUTPLY ( 1809_18 10)
11. Meets requirements in 15ANCAC 18A.1700 or 15ANCAC 18C ..........................
IZ Cross-connectionsprobbited ................ ................ ___ ... .................... ..... __ ... _ ....
13, Hot and cold running water provided-, (1 16'-128'F) in guestroorns .......
DR01<ING WATER FACILITIES (.1811)
14, Water cooler, fountain or dispenser approved
15. Muth -use utensils washed, rinsed, sanitized, properly stored and handled, approved
facilities if required. __ ... ........ ........ ---------
I& Ice buckets with liners, ice bucket lids washed, rinsed and sanitized in an approved
manner...... "___ ...... ____ ... ____ ...... ......................
17. Ice machines clean and in good repair; ice machines meet requirements ...
18, Ice stored and lomidl ed to prevent contarnination, scoops provided, ._ __ _
19, Single service articles properly stored 2nd handled . ...... ...... ......... .......... ... ..........
BEDROOXIS (.1812)
20, Ventilation dean and in good repair ....
21, Outside openings screened unless air conditioned., .................. ...............
22, Lighting meets requirements ... ..................... ....... _ ....... ............. ___ ................
23, Window coverings clean and in good repair ...... ... __ ... _
24, Two clean sheets on each bed, folded under mattress and over cover 6 inches__
25, Sheets, pillow cases, blankets and bed spreads clean andin good repair ....... .......
2& Floors, walls, and ceilings d can and in good repair
27, Furniture, fixtures and accessories clean and in good repair ............. __ .................
2& No roaches, Dies or other pests__ .... ................... _'__ ......
29. Coffee and tea makers kept clean
STORAGE (1813)
30, Storage provided for supplies, linen and equipment kept clean ..................
31, Linen properly handled and stored
32, Supplies on carts properly stored, carts clean and stored properly .......................
TRASH; DISPOSAL OF GARBAGE AND PRENHS ES ( 1814)
33, Garbage containers covered, kept clean, facilities for cleaning,._
34. Rubbish„ litter and other items neat permitted to accumulate on the preirlises'.
35, No undraint�d areas, no fly or mosquito breeding places or to d.cnt harbgragcs
36, Premises kept neat and clean ........ ...... ...... ....... ...... _'_ ...
Inspection by:
Rept Received by:
Mailing Addr:
City:
Deduction
Full
M m
M M 0
TOTAL DEDUCTIONS 2
Owner/Operator
—St Zip
COMMENTS
— SEE COMMENT SHEET ATTACHED "
Comment Sheet Attached
E]Yes [S No
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coydents of aat izr5reob tnrazxxn to mcoil tho zmlt ofisupsctiom xtwde Ibis roymi; developed ioheused in rrAvc inspections of j%stels, ITY-4els, tAirist howns aid sestab w1mventa
PrVara6asa: Lw ad a,nmi-rommittal 1,ealth s pecialists s lain coat uple te it* foTsm emy tams they condad an i ropta tior, pmPare aal origisw and tvo copies for L Origind isc lit ItH w i th the tsysp=xb le pez on, Z
Copy faythis local healfladepartnerd. 3. Copy .lee t=L, Division ofEnvi-twumula Health. D!Vo6WDW71nafbxn Ituy be aesbuyed, in acozaa=e with swidarl-81.6 .'
Impection Recoris, of flat &aaydi Dispoiidor. �hsdsde publisbad by die N,C, Division of Aschim and Tics tort', Additionalfouw sitayba cademd fimv 1632 Mid Semce
Center, RakighNC 27599-163 )Z (Couner52,01-00)
DENR 3977 (Revised 70)
Envirc=xIMI 14ealth Senrics,5 Section (F,AtW 7=)
M,C, Department of Environment and Natural Resources Name: BESTWESTERN
Division of Environmental He, � ID2018200006
A0 ITJ I kTj I =1 z k M1, 9101 =1 z 19111 M I
Street, 1520 13TH AV DR SE
MBMMC��
LJ a
Time In: 0 4 6 Nip
Time Out: 0 4 a
. ' 1 7 p
Total Tirane; 1 minute
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