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oQg�r . SAN JOAQUIN COUNTY <br /> 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 /> • �IFOR�'`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date:/ <br /> Address: Lfj• / ,ti •t PE 2" PR#bZY� '77 <br /> Owner/Operator: Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: #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 /> ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- A6,.vL1031 2 L 3 <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <br /> 2. 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 /> ❑ 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 /> ❑ 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 /> ❑ 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 /> rF-1 <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. <br /> Pest control Used? Rj Yes ❑ No Company Name: rFrequency: 'A«.& <br /> Hotel/Motel Business License? 1AYes ❑ No i-3 t 2�7`3 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: L:22 2_2.3 Z_eel Zf/ A, 7 49 A0 An 2- , 1.17 � Ili <br /> Comments: 243 ve r,; �i <br /> All violations in rooms not inspected must also be corrected. <br /> All re-in ections Oythe Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> 41k �� `�1 (/J <br /> GC <br /> Environmental-Health Specialist: Phone: Page 1 of <br /> / �fvl ci <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />