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aDq���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.sjgov.org/ehd <br /> !FOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1:-5 <br /> `n! Inspection Date: (� /-712D I� <br /> Address: 22 1 o SJ- Novi' mod PE:z4o PR#::IO�✓42-� <br /> Owner/Operaatto`ir: ' � P Phone: '0/09 -% 1 -9)11 (a <br /> V•�09 -% 1,Q„11 <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection I `J �O <br /> #Units in Facility: T_#Units Inspected: 22 1 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:Ge r Qf1eliair or improper maintenance; Broken or non- Sys, �� � P(0) 108 <br /> 2 f ctioni g sink/toile at Lack of hot w ter. Floors: Not clean, pro I co—r d or in bathroom-6yrnI I� <br /> go air.Walls&Ceilin s:Wall lin s n need of cleaning o ai ffoes at Or wilo I n r_e4 ands tr) <br /> damag eelin or eteriorating paint ampness or excessive moisture in roomR,no V <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. <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> �( Garbage Receptacles: Inadequate number of garbage receptacles;Lack of or inadequate 'rn <br /> '`�t 6. close fitting covers;Garbage receptacles unclean or In disrepair. 06a�'` oe°Im Cko <br /> 7. <br /> Public Areas: Unsafe or unsanitary conditions in kitchen, hal-`s,stairways,exits,or other�Ile& rl W O'S CIA�C S' <br /> publicly shared spaces. � rrr <br /> 8. Pest Control: Infestation of insects, vermin or rodents. as <br /> 9. Other Nuisance:Any other condition which is hazardous to health. t��Ul,I1QX�+'1 <br /> Other Substandard or UnsafeConditions:Itlectdcl,structural,or m ing h and Lac ISO 100 10 21 2 <br /> 10. �ro�teccion <br /> quate smoke detect0 ire e i er ; Inadequate ig m na equa 2Z3�— GI(j�ll'1L, Ic <br /> rom weda nadequate s age or water facilities. Q V1 Cc Y� 1000-- PI+ <br /> Pest control Use e o Company Name: Frequency: <br /> Hotel/Motel Business License? Yes ❑ No fl0 x(1. 6 <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: 120 © g W 0 . 23 22 <br /> Comments: Qp't 2I i l"� C�GII"�Q cactrl -Tp cvrsi4 <br /> iso ra e u I erg y) o OnE ma OCU _ rn o cry i <br /> tee. v� h <br /> v , <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health De artment will be billed at the current hourly rate. <br /> Receiv BY. <br /> Environmental Health Specialis : Phone:2mk2Q a n �� S Page 1 of <br /> EHD 24-01 4-30-12 7J HOTEUMOTEL OR <br />