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SAN JOAQUIN COUNTY <br /> ' 'OG 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 /> /FOR'�' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> 7yWh/{'tdkSf '',�N <br /> Address: PE: PR#: <br /> J60u- N ;;"o *'V'u 2y I <br /> Owner/Operator: Phone: <br /> _ 0 <br /> —GIS <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re-Inspection <br /> #Units in Facility: w�#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- <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 /> s. <br /> 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 /> ❑ 5 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 /> ❑ <br /> B. 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. <br /> Pest control Used? R Yes ❑ No Company Name: E,p Frequency: <br /> Hotel/Motel Business License? KYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: #JIJ <br /> Comment . lbs 76 t <br /> N L_%65 o u,4 :;:�K , n MWY <br /> off# <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: MnATitle: <br /> Environmental Heath Sp ialist: Phone: <br /> L2�)I) ,yy Page 1 of 1 <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />