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Pqu � y SAN JOAQUIN COUNTY <br /> _.. r v` EI�, RONMENTAL HEALTH DEPART -ANT <br /> { 1868 East Hazelton Avenue , Stockton , CA 95202 - 6232 <br /> moo Telephone: (209 ) 46&3420 Fax: ( 209) 464-0138 Web: www . sigov . orq/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : [+Utfh4b1W NO WL Inspection Date : <br /> Address : ISk, S tel'' CL OL4604C .17 , VWCX /0j PE : ZNI b PR# : <br /> Owner/Operator: OffsH ioWn 10MI L Phone : <br /> ,Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : 0 # 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- 7� <br /> functioning sink/toileYbath ; Lack of hot water. Floors : Not clean , properly covered or in <br /> 2 ' Uam� <br /> air, Walls & Ceilings : Walls/ceilings in need of cleaning or repair: Hole �r <br /> 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 /> 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 /> ❑ 50 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 /> ❑ 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 asafe Conditions : Electrical , structural , or plumbing hazards ; Lack 3 <br /> 10 . of or inadequ smo a detectors fire extinguishers ; Inadequate lighting ; Inadequate <br /> protection from a sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name : ;rt j! jSFFrequency: ON,�C R /A)/J/W <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 3 L <br /> Comments: 3 dM#f'L Ot7 ✓�au�'L A//AIvuw � gi.J f�� /lir/ <br /> 6o7ft/l" vvr a 1ptr Plnwr r/P oa>L pw,4 t.-Orr y cva <br /> - fiLf"69 6tjitpC7 hLJ fftCfG A2451' <br /> pull <br /> >a s r b lyohl qui <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 /> 12 Z1 AW <br /> Environmental Health Specialist: Phone: <br /> Page 1 of % <br /> EHD 24-01 4-30-12 HOTEL / MOTEL OR <br />