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, q ,y SAN JOAQUIN COUNTY a4 �t r.� ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 ' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www, sigov. org/ehd p• `;GsR HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: PE: PR#: Owner/Operator: Phone: Lj Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: q # Units Inspected : Reinspection On or About: The items checked below are violations to be corrected . See Reverse Side of this Form for Detailed Summary of violations and Code References. Room(s) : El garbage, Cleanliness: Lack of cleanliness & sanitation ; Accumulation of debris, trash, garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- F] on F] 2 functioning sink/toilet/bath ; Lack of hot water. Floors: Not clean, properly covered or in 1 good repair. Walls &Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water damage, peeling or deteriorating paint; Dampness or excessive moisture in room . ❑ 3' Heating : Lack of approved heating in each unit; Approved heater not maintained in a safe, working condition; Lack of adequate heat (Standard: 70'F at 3 feet from floor). Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing & sanitizing after each use (multi-use); Lack of or improper protective bagging (multi-use) or individual protective wrapping (single-use). F-1 5 Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate ❑ close fitting covers; Garbage receptacles unclean or in disrepair. F-1Public Areas: Unsafe or unsanitary conditions in kitchen , hallways, stairways, exits, or other 7. publicly shared spaces. ❑ a. Pest Control: Infestation of insects, vermin or rodents. ❑ 9. Other Nuisance: Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? ❑ Yes ❑ No Company Name: Frequency: {Y,, i ,y ; .� Y Hotel/Motel Business License? ❑ Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : Comments: I All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmental Health Specialist Phone: Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OIR