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V!N, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y; N 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or /q ehd <br /> P <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C Ir,9 1 (7� Inspection Date: 3) <br /> Address: /Sc ,� 2`�--� PE: 2yt PR#: ZY0 0 <br /> Owner/Operator: � p�d e��,.` Phone:/ <br /> Annual Inspecti n ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: #Units Inspected: q I Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Surnmavy 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 /> E] 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 /> ❑ 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 /> ❑ 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 /> ❑ <br /> s. <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 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?Kyes ❑ No Company Name: 2 /1 n-t eFrequency: 77107 <br /> Hotel/Motel Business License? ;Rle—s ❑ No ,S j rl�4 W oM,c 60 7 —t -P—o k, <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: I b <br /> Comments: •e I 'r' / evs <br /> All violations in rooms not inspected must also be corrected. <br /> All re-ins ections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> �� Ph-L m Ohw, <br /> Environmental Health Specialist: %C Q , Phone: ZU 3 <br /> 1, C� Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />