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SAN JOAQUIN COUNTY <br /> %` ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.swgov.org/ehd <br /> •••��FOR`'`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: 13 C e n f ear <br /> 5 t ' PE:Z y09S PR#D J�y_o 11 <br /> T <br /> Owner/Operator: Phone: qOVeIn _ &, 77CA- ,rte <br /> Annual Inspection <br /> Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: ,� #Units Inspected: Reinspection On or About: <br /> The items checked bel are violations to be corrected. <br /> See Reverse Side of this Form for Detaile ummary of Violations and Code References. Room(s): <br /> ❑ 1 Room Cleanliness:Lack of cleanliness& nitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar mater) <br /> Room Maintenance:General lack of repair or im per maintenance; Broken or non- <br /> F-1 2 functioning sink/toilet/bath; Lack of hot water. Floors. of clean,properly covered or in <br /> good repair.Walls&Ceilings:Walls/ceilings in need o eaning or repair: Holes,water <br /> damage, peeling or deteriorating paint; Dampness or exce ive moisture in room. <br /> Heating: Lack of approved heating in each unit;Approved hea not maintained in a safe, �. <br /> F-13. working condition; Lack of adequate heat(Standard:70°F at 3 fee om floor). j <br /> Drinking Utensils&Ice Buckets: Not protected from contamination; La of or improper <br /> ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper prote 've bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> ❑ 5' Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free fro filth or <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequat <br /> ❑ 6. 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. <br /> Pest control Used? Yes ❑ No Company Name: p -i Frequency: � '1r <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: Z <br /> Comments: c) I_e_ Ie cC ti► �,' e 1'S O S V" x,.3-1°�� <br /> rA, I.✓vr b <br /> Vd ecoMe_4..e1_ For off rot a l< <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: -3, i%f I VA ql't"A. I / Title: /L <br /> Environmental Health Specialist: 'r7 Phone: �A4 y0 d Page 1 of <br /> EHD 24-01 4-30-12 ! HOTEUMOTEL OR <br />