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rSAN .1OAQUIN COUNTY <br /> pq . . . .y <br /> '� " F .c° ENVIRONMENTAL HEALTH DEPARTMENT <br /> i �..,� 1868 East Hazelton Avenue , Stockton , CA 95202 - 6232 <br /> � •*44 FAIR *RTelephone : (209 ) 468 - 3420 Fax: (209 ) 464 -0138 Web : www . s4gov . org /ehd <br /> 4�• FO HOTEL/ MOTEL OFFICIAL INSPECTION REPORT <br /> FAddress : <br /> Facility : j + � ^ ` Inspection Date : Zfi U2 �) <br /> - R U r n -a PFS: P #� r" <br /> eo <br /> it <br /> O erator: 1 'A mot g�tRobot <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : tlw # Units Inspected : ZReinspection 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- <br /> ❑ functioning sink/toilet/bath ; Lack of hot water . Floors : Not clean , properly covered or in <br /> 2 ' 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 /> ❑ <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 /> F❑ 4 . washing & sanitizing after each use ( multi-use) ; Lack of or improper protective bagging <br /> (multi- use) or individual protective wrapping (single- use) . <br /> F] Beddin : Mattress/linens infested with lice , bedbugs , or other insects ; Not free from filth or <br /> 5 . 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 /> ❑ Public Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other <br /> 7 ' 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 oLUnsate Conditions : Electrical , structural , or plumbing hazards ; Lack 0 9 two, d n �fi � a <br /> [� lo , of or inadequate smoke de c61r or fire extinguishers ; Inadequate lighting ; Inadequate ba �er �/ <br /> protection from west er; nadequate sewage or water facilities . VV <br /> Pest control Used ? Yes E] No Company Name : v Frequency : <br /> Hotel/Motel Business License? KYes ❑ No ( ill 1 ,30 Z02 Monsoon <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : <br /> Comments : Rob <br /> X npiA Ij ✓� <br /> r <br /> All violations in rooms not inspected must also be corrected . <br /> All -ins cti by the Environmental Health Department will be billed at the current hourly rate . <br /> Received By : Title : <br /> Environmental Hea Specialist: Ia j . Phone : g �/� — �? Page 1 of <br /> !� IU HOTEL/MOTEL OR <br /> EHD 24-01 4-30- 12 <br />