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oAgV,y o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> i�A t <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> •' Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: O'C l I c M( C MotelInspection Date: I U 3 % <br /> Address: I�3S , �ltl"i I S o m W� _ W Ph PR#'O 2-7 OW S <br /> Owner/Operator: IN (�� I&Ajie: Phone: C z C'9 )9 <br /> Annual Inspection ❑ Complaint Inspection ElConsultation Inspection E] Re-Inspection <br /> # Units in Facility: ZC #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' <br /> ❑ 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). v (Af <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 /> ❑ 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? Yes E] No Company Name: U I OV MiN P S Frequency: n U�1`� I <br /> Hotel/Motel Business License? XYes ❑ No ENZ lo <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: Ll 19— <br /> Comments: <br /> Foo &k Ve s n v Ke kel e CfVK <br /> fWj Fi je ker S <br /> �{ (44 Cohh2'w 0. "c^I, -'U �er� <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: I c'�WTitle: �. atc-cf- <br /> Environmental Health Specialist: Phone: 'L09) YC6- <br /> 3 Z Page 1 of <br /> t <br /> EHD 24-01 4-30-12 / 4Z_ HOTEUMOTEL OR <br />