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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT `� �►` 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.si-gov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � � Inspection Date: Ell Address: PE:c2 oSPR#:'2Owner/Operator: Phone: r. nnual Inspection ❑ Complaint In pection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: #Units Inspected: I Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, garbage,combustible items or similar materials. Room Maintenance:General lack of repair or improper maintenance; Broken or non- 2. functioning sink/toileUbath; Lack of hot water. Floors: Not clean,properly covered or in good repair. Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness or excessive moisture in room. ❑ 3' Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,working condition;Lack of adequate heat(Standard:70°F at 3 feet from floor). Drinking Utensils& Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing&sanitizing after each use(multi-use); Lack of or improper protective bagging (multi-use)or individual protective wrapping (single-use). ❑ b Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers;Garbage receptacles unclean or in disrepair. 7.❑ Public Areas: Unsafe or unsanitary conditions in kitchen,hallways,stairways,exits,or other publicly shared spaces. ❑ 8. Pest Control: Infestation of insects,vermin or rodents. ❑ 9. Other Nuisance:Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack f,1v..2.0-4- T-e f lug! 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate {Lm Z to protection from weather; Inadequate sewage or water facilities. Pest control Used?MYes ❑ No Company Name: Frequency: Hotel/Motel Business License? ❑Yes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire ❑Other Rooms inspected: p- ZIII, y Comments: All violations in rooms not inspected must also be corrected. e-ins a 'on the nvironmental eealth De artment will be billed at the current hourly rate. Receiv d B Title: Environm e h S ebalis . Phone: Page 1 of EHD 24-01 4-30-12 HOl EUMOTEL OR