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SAN JOAQUIN COUNTY <br /> 2Y ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> 'P <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: n Inspection Date: <br /> Address: P PR#: <br /> /3 3 3 F !Z>,- M LK <br /> ,Jr /�d• �1 Z oi �3 <br /> Owner/Operator: Q' , /a Phone: <br /> K Annual Inspec on ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: #Units Inspected: U Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Fonn for Detailed Summary of Violations and Code References. Room(s): <br /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1' garbage,combustible items or similar materials, <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- <br /> 2' <br /> ❑ 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 /> ❑ 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 /> ❑ 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 /> lq <br /> Pest control Used? Xyes ❑ No Company Name: Frequency: /ZPo r-1% <br /> Hotel/Motel Business License? [ .Yes ❑ No 0 , I <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: tis 1 ZV 1 1 '2--7 Z 13 2 to 135 <br /> Comments: <br /> Wo Vt° <br /> All violations in rooms not inspected must also be corrected. <br /> All re-ins ctio b Environmental Health Department will be billed at the current hourly rate. <br /> Received By: � G^� Title: t�A <br /> Environmental fqealth Specialist: Phone: r L,�,, j Page 1 of <br /> EHD 24-01 4-30-12 "[ HOTEUMOTEL OR <br />