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0911 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.sagov.org/ehd <br /> hi HOTELIMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: � � Inspection Date: d 9� <br /> Address: .s u1Uc Pal�� Q� Y <br /> Owner/Operator: CA-1 �� �� 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 /> ❑ 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- 4Ao.ws`rZn,t D <br /> 2' functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in hn L03" <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). <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 /> T5. 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 /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate CN^'�/3'�{'t"r�o-��vclose fitting covers; Garbage receptacles unclean or in disrepair. <br /> 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 det ors or fire extinguishers; Inadequate lighting; Inadequate <br /> 11 L <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? EKes ❑ No Company Name: Oven Frequency: <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: s' Z <br /> Comments: - o <br /> All violations in rooms not inspected must also be co ected. <br /> All re-inspections b the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: /___r c_ Title: <br /> Environmental Hea h Specialist: Phone: / r/0 Page 1 of <br /> EHD 24-01 4-30-12 Q LLSS HOTELIMOTEL OR <br />