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oPq�,y c SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />y` 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />'• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />4�/FORt'HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility:e <br />S� iio� <br />Inspection Date: <br />�z 3 <br />Address: S S J� (1 ^� . S �� L YtU�'1 <br />PE: , yl' S <br />PR#: CI LYv� 3� <br />Owner/Operator: G��, f Cf V K (� M� r K <br />Phone: <br />Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: # Units Inspected: Reinspection On or About: <br />The items checked below are vi lations to be corrected. <br />See Reverse Side of this Form for Detailed Summary of Violations and Code References. <br />Room(s): <br />❑ <br />1 <br />Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />garbage, combustible items or similar materials. <br />2. <br />Room Maintenance: General lack of repair or improper maintenance; Broken or non- <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 />rr__�j <br />Heatin : 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 />A3. v <br />4. <br />Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />V 101 'q 10 'Vs <br />V <br />❑5. <br />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 />6 <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />close fitting covers; Garbage receptacles unclean or in disrepair. <br />❑ <br />7. <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />publicly shared spaces. <br />❑ <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />❑ <br />10. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br />protection from weather; Inadequate sewage or water facilities. <br />Pest control Used? es ❑ No Company Name: tl �° Jt Frequency: -k.t <br />Hotel/Motel Business License? K Yes ❑ No 11 <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: <br />Comments: <br />n r< e L °✓ Q .) e(V e4k -,,rcV 5 - <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 />Received By: Title: <br />r <br />Environmental He ialist: � Phone: (J _,'�� j� <br />I r� <br />Page 1 of <br />HOTEUMOTEL OR <br />24-01 4-30-12 g �s ") �G <br />