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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 /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: inspection Date: <br /> Addres��.__ PE:2,Li)6' PR#- 'q,,_3o <br /> Z741 .5-0 e)2- <br /> Owner/Operator: Z) Phone: <br /> T_OU7T-- <br /> Annual inspection El Complaint inspection Ej Consultation Inspection ❑ Re-inspection <br /> #Units in Facility: _T#Units Inspected: . L4 I Reinspection On or About: A/A, <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. <br /> Room Maintenance:General lack of repair or improper maintenance;Broken or non- <br /> E] 2� functioning sink/toileVbath; 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 /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> F] 1 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 /> El 4, washing &sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> Ei 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 /> El 6. <br /> close fitting covers;Garbage receptacles unclean or in disrepair. <br /> ❑ 7, Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways, exits,or otheri: <br /> publicly shared spaces. <br /> F] 8. Pest Control: Infestation of insects,vermin or rodents. <br /> El T9. 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? M Yes 0 No Company Name:Ca0+14 N41—mi;Zffrequency: rld 12%42� <br /> Hotel/Motel Business License? Ej Yes Ej No V &_ <br /> Multi-Jurisdictional Violations to be Referred to:El City Building/Code Enforcement/Fire[:] County Code Enforcement/Fire E]Other <br /> Rooms inspected: <br /> Comments: <br /> MAM An, <br /> All violations in rooms not inspected must also be corrects 4. <br /> All re-inspectionsby-the Environmental Health Department will be billed at Me current hourly rate. <br /> Received By: A_Z�ej_-,4 Title: <br /> Environmental Health Specialist: Phone: 6 Page 1 of <br /> EHD 24-01 4'30-12 HOTEUMOTEL OR <br />