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o¢agl>r. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> k, 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s4gov.or /q ehd <br /> ♦•4�IFpR�`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` �\ Inspection Date: 01 Z4 ZZ <br /> i <br /> Address: CJ. , PE:` PR#: )2 <br /> Owner/Operator: �` Phone: <br /> �f Annual inspection Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: l"- [—#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- 11,011tcl�r`�'� <br /> 2. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in ��4#vw(4 °r �►��k <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water Z�Z � <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ 3 <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 /> E] 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 ❑ No Company Name: L s z�f\`a ,rjequency: <br /> Hotel/Motel Business License? [ ,Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building! ode Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: I �I \} az7.� — '21 Y <br /> Comments: 4v j 11111V <br /> 2 c? root lY ` <br /> 1 <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmentll Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Health Specialist: i Phone: � ,D" / (t� 3o Page 1 of <br /> EHD 24-01 4-30-12 \ HOTEVMOTEL OR <br />