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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 /> P <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: \(\0 4insctionpeDate: <br /> rL i <br /> Address: E:.It(-20q) <br /> PR#: 0,5Owner/Operator: paf I tpw,� 1��j hon /t j„ _2951 <br /> F1Annuual Inspection ❑(Jcolmvpllaint Inspection ❑ Consultation Inspection ❑ Re-Inspection `f W <br /> # Units in Facility: 2. # Units Inspected: I Reinspection On or About: <br /> The items checked below are violations to be corrected. Room(s): <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. <br /> F Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in ,Vt bru VI I I SIIU <br /> 2. good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water 11 <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> F] 3. Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> 3. 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. <br /> Pest control Used? Yes ❑ No Company Name: ART Frequency: <br /> Hotel/Motel Business License? Yes ❑ No I 2 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: l <br /> Comments: d r-6 <br /> OP V-Pd ITIS rf] <br /> All violations in rooms not inspected must also be corrected. <br /> All re-insiMections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Health pecialist: !' Phone: 2. Page 1 of <br /> W <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OR <br />