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c SAN JOAQUIN COUNTY <br /> oc <br /> �Q ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue Stock - <br /> , ton, CA 95202 6232 <br /> c _ P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: "DC-I-M #0jZFZ_ Inspection Date: <br /> Address: <br /> ,2L// , ! joeOillld PE:�Ov PR#:OBD OSI <br /> Owner/Operator: 1"VlA10 p/�Tm Phone: <br /> ❑ Annual InspectionX Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: I 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 /> garbage, combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> F] 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 /> ❑ 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 /> ❑ 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 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 /> protection from weather; Inadequate sewage or water facilities. 04a 4L: <br /> Pest control Used? es ❑ No Company Name: Q04'l-/42t -1t% &tj-, Frequency: 00nj n1 L 9 <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: <br /> Comments: Wf1r6/1l)41_ /�ftO1(50 0 tJ 01311-1 l- 77fi`t( fjc�Cl oM 1- j)4rf 5 -749 v07" <br /> C'Orpt-vi?W. <br /> 4U ri �TGSO lr f "961ptrT 0/4 00u �l y <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 /> Rece d By: Title: <br /> Environ a Phone: �/�: '���9,� Page 1 of <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OR <br />