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„qWy 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.s'gov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: , Inspection Date: <br /> Address: / .�1 l PE:Zgj j PR#: 2�afd�� <br /> Owner/Op-�r: A.[', ,�('.a Phone: <br /> A. AAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facili y: # Units Inspected: 6' 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- J1240 ^4- M;-. <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 Aw�vch /tet Ole <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. 4Mee <br /> ❑ <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 /> El 5 Beddin : 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 /> F-] 6. 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; Lack 'vwee <br /> f 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? Kes ❑ No Company Name: Frequency: K,-/ti <br /> Hotel/Motel Business License? X Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 26Z 26 <br /> Comments: J S <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: s”�,� �� � r Title: <br /> Environmental Health c�ia-list/: Phone: 7 Y Page 1 of <br /> EHD 24-01 4-30-12 �"7 HOTEUMOTEL OR <br />