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U1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> **-*I I I .. g/ehd <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov. r <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address* 24.3 -f_a� 4:L ;7 (30L- <br /> _p <br /> �wner/operator: Phone: <br /> ............. <br /> Annual inspection n Complaint inspection 0 Consultation Inspection El Re-Inspection <br /> Units in Facility: - <br /> #Units inspected: (p 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 /> El 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 /> 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 /> r 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 /> Bedding:Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> ❑ 5. <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> E716 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 /> publicly shared spaces. <br /> Ej 8. Pest Control: Infestation of insects,vermin or rodents. <br /> F] 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? �'es El No Company Name: 6.1� Frequency: Ooo�A7 /V <br /> No <br /> 1^ 1 <br /> Hotel/Motel Business License? yYes El <br /> Multi-Jurisdictional Violations to be Referred to: []City Building/Code Enforcement/Fire[]County Code Enforcement/Fire Ej Other <br /> Rooms inspected: /Q5' / j ec. ,Yfey / /00 7VI , 2-iZ <br /> Comments: <br /> Me,-I <br /> 46 VoI4.4.-.rads cr c.Z a <br /> ,/_ <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: t;�CIA t EIAL _PQ 4-1 Title: Imawpuee <br /> -Y Cf?wh <br /> Environmental Heafth'Specidlist: Phone: - age 1 of <br /> I - <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />