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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ` Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �4 C•1 F O RT�`4' <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: QS'C� C.fie Inspection Date: <br /> Address: 13 of St r /S O ?) V� Q leo G PE: 2 Ll f 7 PR#:/(9 21,1 <br /> Owner/Operator: &Y-6 , L"-{ M y' U i <br /> Phone:l(CSO) (92- <br /> Annual) spection F1 Complaint Inspection F1 Consultation Inspection ❑ Re-Inspection ` 6 <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 /> 2. <br /> on- <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 <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 /> ❑ b 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 /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> ❑ 6. 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 — j Nor <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate C-0 yYcE�Y <br /> protection from weather; Inadequate sewage or water facilities, Ke <br /> (4pV <br /> Pest control Used? Yes ❑ No Company Name: C(tkf Frequency: — MD(Ct° k e- eC Y <br /> Hotel/Motel Business License? N Yes ❑ N <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other <br /> Rooms inspected: joy y <br /> Comments: y <br /> eYrf <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 /> eceived By: Title: _ <br /> Environmental Health Specialist \� �' Pho e: Page 1 of <br /> EHD 24-01 4-30-12 (J c�Y / d HOTEUMOTEL OR <br />