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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.sigov.or /y ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: ]' <br /> Address. PE: PR#: <br /> ✓��OV3 Qtt,, Ic. L o 00 <br /> OwneOperator: j � ^ n I • Phone: <br /> +�¢i -�„ `(�CA�-lam <br /> ",Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility Q # 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- V'%%7-q-- <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in Ab 0-00A'-�! <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water �y�Zz�16r - &,,.& " <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. hnk t <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a sa (L,KZ,pq t�avrllt!r�e iwc <br /> F-1 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 A" <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 <br /> 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 /> ❑ s Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate Vhcw►��'�-"�P�.s d�� <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. &p't' <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 12.n-. `A 15't 9 442. <br /> 10. of or inadequate Fmoke detectors r fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? ❑Yes ❑ 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: SO g a 3 2- 2.© <br /> Comments: 2„3 <br /> perp / _ MW <br /> 2 <br /> b1A t fit+ 6 <br /> c- <br /> All violations in rooms not i ecWA must�_ calso be corree <br /> All re-inspections by the Environmental Health Department will be billed at t e current hourly rate. <br /> Received By: /�a� + � � Title: <br /> Environmental Health Specialist: Phone: [J L Page 1 of <br /> EHD 24-01 4-30-12 �I p HOT F L/MOTEL OR <br />