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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.swgov.org/ehd <br /> 4�,FOR��p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 457wh-C lh _d, „ Inspection Date: / � L3 <br /> Address: ! �s� PE: ?,Ilk <br /> PR#:6,516y <br /> L : Z-L <br /> _9wDegOperator: Phone: <br /> Annual Inspection El Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: Z-3 #Units Inspected: 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 /> ❑ 1 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 /> F-1 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 /> ❑ Heating: 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 /> r❑ 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? 7Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License?` Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: �t j 1/S <br /> Comments: -,*-, &,a <br /> 4t t1t <br /> O <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title:/P_%'>_I� v � <br /> Environmental Health pecialist: Phone: _ ! _ Page 1 of <br /> EHD 24-01 4-30-12 l HOTEUMOTEL OR <br />