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oAq�,y c 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.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C ( �l i�t 1 Inspection Date: <br /> Address: �S 'Sm G I �a u t n PE 2_`V <br /> fi PR#:021+0 <br /> 20 0 <br /> Owner/Operator: Mel , <br /> p iI m�ry��S h Phone:r ZO 0 g 4 G _ 53 <br /> U U J <br /> Annual Inspection [:1 Complaint`Inspection [:1 Consultation Inspection ElRe-inspection <br /> I D <br /> #Units in Facility: 2 # 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 /> ❑ 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 /> ❑ 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. 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). <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 ICG -Matt 03 fYi!oRaCiT r <br /> 10. of or inadequate<smoke detectslrs or fire extinguishers; Inadequate lighting; Inadequate fY,3- <br /> protection from weather; Iriadequate sewage or water facilities. <br /> Pest control Used? X Yes ❑ No Company Name: , t ) Frequency: MEE <br /> Hotel/Motel Business License?,IX Yes ❑ No Ni'; ( • U • CSL(i <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: lJ <br /> Comments: <br /> f <br /> all 0AM.S . <br /> i <br /> All violations in rooms not inspected must also be corrected. <br /> i411 re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received B Title: , <br /> Environme He ialist: Phone: _�, Page 1 of <br /> EHD 24-01 4-30yOR <br />