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SAN JOAQUIN COUNTY <br />�°•per •�o <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />"- 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />'% '' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: v -F0rd, Wjg�-zd <br />Inspection Date:vzy/)9Address: <br />q ✓.S <br />Q . �.(",VOY(' s`l/S-60 ton GA. Zo2 <br />PE: M <br />PR#:OZOU�O./ <br />Owner/Operator. �a G21 <br />Phone: Nob 55007b % _ d <br />Y60 <br />Annual Inspection El Complaint Inspection El Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: 3 # Units Inspected: `j <br />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 />❑ <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 />❑ <br />2. <br />functioning sink/toilegbath; 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 <br />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 />❑ <br />4. <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />❑ <br />5. <br />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 />❑ <br />6 <br />Garba e Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />close fitting covers; Garbage receptacles unclean or in disrepair. <br />7T <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />rM <br />publicly shared spaces. <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />❑ <br />10. <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: d I IL Frequency: -f <br />Hotel/Motel Business License? 21 -Yes ❑ No I <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: Q) 9 Z 0 Z' (� <br />Comments: r � V Y4- - j e V Q <br />1 "Lr -e- Voa pj ,ten ej- n if ok V00nS o 71"eVS <br />p 111' 1 0/� ► o 'Yt S <br />All 'olations in rooms not inspected must also be corrected. <br />All r -'sections a Environmental Health Department will be bRed at the current hourly rate. <br />Received By:- • -�� Title: <br />Environmental Health ecialist: A$ � C r / Phone: p „ J" <br />Page 1 of <br />EHD 24-01 4-30-12 HOTEL/MOTEL OR <br />