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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 1'•. .' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: i� 1 r�rr Inspection Date: v= 3i 1�%Z Address: , / w� . PE: PR# Owner/Operator: J Phone: [Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection # Units in Facility:' # Units Inspected: j Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): ❑ 1 Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non - F] 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water damage, peeling or deteriorating paint; Dampness or excessive moisture in room. ❑ 3 Heating: Lack of approved heating in each unit; Approved heater not maintained in a safe, working condition; Lack of adequate heat (Standard: 70°F at 3 feet from floor). Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing & sanitizing after each use (multi -use); Lack of or improper protective bagging (multi -use) or individual protective wrapping (single -use). ❑ 5 Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. F] 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair, ❑ 7. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other publicly shared spaces. ❑ 8. Pest Control: Infestation of insects, vermin or rodents. ❑ 9. Other Nuisance: Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack 10%0-0 )ft—v't 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate Left-ocl-el e.Ls.-fe protection from weather; Inadequate sewage or water facilities, Pest control Used? [Yes ❑ No Company Name: 6 �' � iL Frequency: Hotel/Motel Business License? Y Yes ❑ No I L — 2,7 — 7e— i�Z Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: '2e � " 2- 2 C q ..5c t Comments: r L 1/ctf,CCA e-e-ZA—Wo 11067— All violations in rooms not inspected must also be corrected. All re-inspeeMons b the E onm ntal Health Department will be billed at the current hourly rate. Receive B Title:�� Nliq Environnlel Health nkcjbim Phone: Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR