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u. SAN JOAQUIN COUNTY <br /> pq• ^1. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> bil <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.or /q ehd <br /> gCii OElt <br /> P HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: D� r a Inspection Date: 1 16'12 <br /> Address: vis S ' 1' j &Y) S- OC I�`�j`�'1 PE: Z(��9- PR#:�Zy <br /> Owner/Operator: tn 1/�© C'�V'� I , Phone: 20�� 20 —j US` <br /> Annual I spection ❑ 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- p,S — tL ft e- <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in �j {�-�o(�� 41- 1'0T- <br /> good <br /> 0T <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water .�wf-CY Ki EzkM 5,�+IC <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> rF-1 <br /> Heatin : 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 /> ❑ <br /> s. 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 i,_3`7—j0ett' t �re <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or wa er facilities. <br /> Pest control Used? Yes ❑ No Company Name: Ofti(r C- Frequency: <br /> Hotel/Motel Business License? ❑Yes ❑ No Xl° �•� i` r r S Z <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected O U Y <br /> Comments: (WHIG 6 V- y'eA-0Vr_ roe^ <br /> i Y� 2h � �1�G-e.4:S I a.. Vc:C�✓'� <br /> w VeasvNQ fa' i/Gi V'lut.V' <br /> All violations in rooms not inspected must also be corrected. <br /> All re-Insnections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Health Specialist: C Phone: Zv) 1�ti _ 3 �� Z.(J Page 1 of <br /> EHD 24-01 4-30-12 JJ HOTEUMOTEL OR <br />