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o,gUV,y SAN JOAQUIN COUNTY <br /> r. err ENVIRONMENTAL HEALTH DEPARTMENT <br /> ¢• •Za <br /> W- 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> p <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: /7C� O6fj Inspection Date: <br /> Address: 9 + W t S 0/n �G� CK�C7 PE:Z'1 I� PR#:�Z %l Z Z <br /> Owner/Operator: So—Y e (^ ou C Phone:(�o9) /' <br /> nnual Ins ection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: 2, 1 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 /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> F-1 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in r� <br /> „ <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water 117 <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. 0 <br /> r4. <br /> Heatin : 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 /> 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 /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <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. <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? es ❑ No Company Name: Frequency: 0'tk <br /> Hotel/Motel Business License? Yes ❑ No Tt- <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> 11 <br /> Rooms inspected:9 5 <br /> Comments: w l (( ire .. 71n t'M c C ( 7 v SS <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:c1 Title: <br /> Environmental Health Specialist: /C )WA Phone: w s>`" t Page 1 of <br /> EHD 24-01 4-30-12 ( HOTEL/MOTEL OR <br />