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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> t• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> q�6: p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: 121 <br /> Address: , Ub� O 1. n TO-2- PE: bb PR* <br /> : <br /> Owner/Operator: 1 Phone: <br /> Annual Ins ection ❑ Compfaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: #Units Inspected: ILA 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 /> garbage, combustible items or similar materials. ,�Q <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> functioning <br /> on 'Z'tU I / <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 121:� LA <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <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 /> ❑ 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 /> F-1 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> F-17. Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits,or other <br /> 7' publicly shared spaces. <br /> 8. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 97 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: Frequency: <br /> Hotel/Motel Business License? [ ,Yes ❑ No ,61 2D21 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code EnforcementlFire❑ Other <br /> Rooms inspected. 2 Z 2 2321 _ <br /> Comments 6 — cICY66d 5 � E�• � <br /> LsqB k 5. <br /> 1 tAil &C 14 ME <br /> 2 <br /> All violations in rooms not inspected must also-6e corrected. <br /> ins ections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By. title: <br /> Environmenta a Specialist: (�� (� i Phone: 6 Page 1 of <br /> t'1 �` <br /> HOTEUMOTEL OIR <br /> EHD 24-01 4-30-12 <br />