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Pq�,y SAN JOAQUIN COUNTY <br /> �o. t.co ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> •'= '' Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.or /q ehd <br /> 4�i'FOR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: IInspection Date: 2 <br /> ReA �'+ n <br /> Address: <br /> PE: O PR#: 2 <br /> W�on�- 5 LO <br /> Owner/Operator: p \ �'Va�+ Phone: _6ef <br /> Annual Inspktion ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: q einspection 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' <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in i <br /> good repair. Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water Z b� <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <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 /> ❑ 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 /> ❑ 6 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 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. 2 .2 <br /> Pest control Used? Yes ❑ No Company Name: P, Frequency: p <br /> Hotel/Motel Business License? Yes ❑ No t L 12Z <br /> Multi-Jurisdictional Violations to be Referred to: F-1City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire El Other <br /> Rooms inspected: ' 0 . <br /> Comments: I_ f a <br /> o, <br /> 114 k <br /> L 4 <br /> CI (� <br /> All violations in rooms not spected must also be corrected. <br /> All r -inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received B Title: <br /> Environment- ealth S ecia ist: l Phone: ,/I,� ' /` Page 1 of <br /> HOTEL/MOTEL OR <br /> EHD 24-01 4-30-12 <br />