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SAN JOAQUIN COUNTY <br /> �Q. ENVIRONMENTAL HEALTH DEPARTMENT <br /> y big 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:vvvvw.sjgcv.orq/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date:� .- <br /> &��S <br /> Address: /!»5` /W �� '�Jt>~ c c, �f_ PE�Oe PR1:7zq <br /> Owner/Operator: Phone: <br /> ,�ufd-�.w. Cfoh•�5r.� <br /> [Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: $ 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- <br /> ❑ Z' 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 /> F-1 3. 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 /> ❑ 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 /> ❑ 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? 0,Yes ❑ No Company Name: Frequency: AA,,* <br /> Hotel/Motel Business License? Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 1 0 9 10822 27 0 ! Z3 Z <br /> Comments: <br /> riz- — �. <br /> ?-mots- <br /> All.Violatio s in rooms not inspected must also be corrected. <br /> All re ' s ections b ;the iron ental Health Department will be billed at the current hourly rate. <br /> Received By: ` Title: <br /> L-t <br /> Environmental ealth Speci St: Phone: <br /> 1 fid^ 3 S Z Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />