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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> C;.ki 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> iEbo HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �1 M p Y l C6L� ; /Y1 77 C Inspection Date: ( {� D 7 2 <br /> Address: r'5O�J ` C trt- /' /` v� U to c-�L f Oln PE:Z q0k PR#: O/ 20� C^^A, J <br /> Owner/Operator: (' h e x ax- YM � � l 'L Phone: ( 0) �q S <br /> Annual Inspection MLA, o., <br /> Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> (J T T <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- 11 not <br /> dl- <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 /> 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 /> ❑ Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> 6' 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; Lacki 3 5►'h <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate 51'%6K*_ <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Kyes ❑ No Company Name: Frequency: 770 W?-6 <br /> Hotel/Motel Business License? >,Yes ❑ No 10 L3 3 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: ?A0 2i 112 �0 ZO8 Lo C Lc)S <br /> Comments: 11 1 <br /> 1 11 Pic 0/1.1'10 V <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: <br /> Environmental Health Sp ialist: LK one: `ZQ� D Q� Page 1 of <br /> EHD 24-01 4-30-12 1 O HOTEUMOTEL OR <br />