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.CL. , 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:wvvw.sigov.org/ehd <br /> 4�lFOR�`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ eC(A k t Ve, 77 YL Inspection Date: ) Z,Z <br /> Address: / (' � �� PE:��I PR#: Z Z <br /> Owner/Operator: ✓C�`)f Phone: t� <br /> nnual Inspection ElComplaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: #Units Inspected: 2_ 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, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- A10❑ 2 functioning sink/toilet/bath; 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 /> ❑ 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). V at[o <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 /> ❑ <br /> 6Garbage 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 /> j1 protection from weather; Inadequate sewage or water facilities. <br /> V Pest control Used? Yes El No Company Name: Ltt -- �` Frequency: <br /> Hotel/Motel Business License? Yes ❑ No �';��, !-r �.;,; , !�,+v`. Pic' °� <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: <br /> Comments: <br /> r� e e6 G I-,� <br /> recon lid <br /> All violations in rooms not inspected must also be corrected. <br /> Ale-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: Cl,,�C y' <br /> Environmental Health Specialist: ` '� �, % Phone: G, — . Page 1 ofco <br /> 1 <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />