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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.sigov.or /q ehd <br /> FOR HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1/ O ,•,L� q Inspection Date: 1 f" <br /> Address: :3 7–, 9,,�,�Yoro, (J C% CM <br /> q7 CA, _ .S Z O Z PE:Z l�j f� PR#: OZ q )09 <br /> Owner/Operator: �,qp �hKu Phone:/ 7U9 TQO <br /> Annual Inspection ❑ Co plaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: 3 C #Units Inspected: 5 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, Til)y */°� ''/ <br /> LA garbage,combustible items or similar materials. CMIem"'+ <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- 0- <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in C0Vey <br /> 1�1 good repair,Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water Z`�';�,,�K K"Vh <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 /> ❑ s Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> 7. publicly shared spaces. <br /> ❑ B. 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 3110 x Z et c`` C d (,LS <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate 5. "�c� <br /> protection from weather; Inadequate sewage or water facilities. — � i <br /> 'Y <br /> Pest control Used? Yes ❑ No Company Name: j')1 Frequency: ih k"'t 1 <br /> Hotel/Motel Business License? es ❑ No 'tN ' 9 , 'Z Y L5, A Z <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other <br /> Rooms inspected: I <br /> Comments: a K'LCA 1n N U dG� ° rn�ttiY�c�r-� c�mat- • X1''7 i !/`c��n cxz Q_ <br /> . V0rV_1h3 S(1ow '/lIEA­�3 3 kO V6V ` LvO r e,ka t,-S e qo o G' <br /> u i)44aS Ck�►•3 e►roY C -60A <br /> 1�7fihV6L4fZS <br /> ✓C:L tl_t V efli, <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspec ' s by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: /15 A / <br /> Environmental Health S t. 'a <br /> j, �l one: ��� ���— Page 1 of <br /> V� HOTEVMOTEL OIR <br /> EHD 24-01 4-30-12 <br />