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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> , • t pal M•" Telephone: (209 ) 468- 3420 Fax: (209 ) 464-0138 Web : www . slgov . or /q ehd <br /> q � / FOR% HOTEL/ MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : <br /> Inspection Date : i I c� te7 1 <br /> r <br /> Address : `� , 1� L � � ,� � v , j ' P � � P 1. © d � �'Ik <br /> Owner/Operator: , � r � ` ' 45 0 c 15 'L <br /> K Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : # Units Inspected : ` ID 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 /> rtA <br /> Room Cleanliness : Lack of cleanliness & sanitation ; Accumulation of debris , trash , �- V�10140T JA il <br /> 1 <br /> garbage , combustible items or similar materials . 2AZ h43 g �iMIE i�t�o� G'� <br /> Room Maintenance : General lack of repair or improper maintenance ; Broken or non 1Y1 C�' fl <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 /> ❑ 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 • foul matter; Unsafe ; Linens not changed weekly or before new guest . <br /> ❑ <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 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 ? KYes ❑ No Company Name : Pjj tA 1 4* Frequency : (; '(� � <br /> Hotel/Motel Business License? -Yes E] No "2.0 '' la j <br /> Multi -Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : ttz� , !5 Z =) v 24C ; Yi 'Z1 Z <br /> Comments : P 1it (a W1 vitS <br /> � b 1 4 <br /> 1, 11 , I , <br /> C � . <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 : a 10� Title : � 1 <br /> Environmental Heath Specialist: CW <br /> �lnG Phone : j lL�. 3 Page 1 of <br /> t HOTEUMOTEL OR <br /> EHD 24-01 4-30- 12 <br />