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o0.Qv , y o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> 'hot • 'pp* Telephone: ( 209 ) 468- 3420 Fax: (209 ) 464 -0138 Web : www . sigov . org /ehd <br /> �� <br /> Qc'; � oR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : j Inspection Date : r� , <br /> I � � f- I.cf V/�.fC1 �� ��' <br /> Address : �,� U E l I � ur 1i f� � PE `` PR �� Vv <br /> Owner/Operator: ut �� I }- ) Phone : (2o q) fes„ /_ /j, G <br /> Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection -! D <br /> # Units in Facility : ;� , i # 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 /> ❑ 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- 4 �� f ►,� L� r <br /> 2 ' 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 /> ❑ <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 /> ❑ <br /> Bedding : Mattress/linens infested with lice , bedbugs , or other insects ; Not free from filth or <br /> 5 • foul matter; Unsafe ; Linens not changed weekly or before new guest . <br /> ❑ <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 /> 70 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 . 11; <br /> Pest control Used ? KYes ❑ No Company Name : YPAI <br /> Frequency : i Q <br /> Hotel/Motel Business License? Yes ❑ No 1 ? 'ai <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : <br /> Comments : C'A.ti 11 C bi IL4 owwrr <br /> 1 [ 6 4elre MY04 LAjlj Irj Y <br /> r� <br /> Pi G <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 : Ate Ac <br /> Environmental Health Specialis Phone : n �j , � r�- � Page 1 of <br /> EHD 24-01 4-30- 12 HOTEUMOTEL OR <br />