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pq��y SAN JOAQUIN COUNTY <br />'o c° ENVIRONMENTAL HEALTH DEPARTMENT <br />N- 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />p <br />�;Yb` ` HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: i <br />i"� I�i/� �� D � � <br />Inspection Date: .���� L <br />I (n <br />Address: I SCS j f [ DpYN <br />Owner/Operator: PoD'An ox t b e- v" <br />Phone: C o)) qtr,_jEr <br />Annual I spection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: 29 <br /># Units Inspected: 3 <br />Reinspection On or About: <br />The items checked below are violations to be corrected. <br />Room(s): <br />See Reverse Side of this Form for Detailed Summary of Violations and Code References. <br />Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />(1u id 0 -- <br />age, combustible items or similar materials. <br />garbage, <br />igarbRoom <br />C' %^ <br />Room Maintenance: General lack of repair or improper maintenance; Broken or non - <br />F -1 <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 />Heating: Lack of approved heating in each unit; Approved heater not maintained in a safe, <br />❑3. <br />working condition; Lack of adequate heat (Standard: 70°F at 3 feet from floor). <br />Drinkinq Utensils & Ice Buckets: Not protected from contamination; Lack of or improper <br />❑ <br />4. <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or <br />❑ <br />5. <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 />❑ <br />6 <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 />❑ <br />7. <br />publicly shared spaces. <br />Pest Control: Infestation of insects, vermin or rodents. <br />rF1o8. <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />❑ <br />10. <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? aYes ❑ No Company Name: - re, V2 ----N i io �, `� r Frequency: n <br />Hotel/Motel Business License? Cyyes ❑ No '�1 Z <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected:IJ5 <br />Comments: <br />y W [ rc coo, P F K_() Wk- <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 />L.iJGlrl� / (M` ira l <br />Environmental Health Specialist: - Phone: (-LU /� yeti _ 3 y LU <br />Page 1 of <br />HOTEUMOTEL OR <br />EHD 24-01 4-30-12 <br />