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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.s'-gov.or /� ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ .5 71 n Inspection Date: Q 3 0/0 <br /> Address: t PE: PR#:0 <br /> ZYv�' <br /> Owner/Operator: C h Phone: <br /> it . <br /> Annual Inspectidin ❑ 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- q C r P>Ct-k V It�-- <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in Cv t/eY <br /> good repair. Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water e-V_<ek Ti <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. Z <br /> 8. Pest Control: Infestation of insects, vermin or rodents. 0Wd^-C-�LG-?_j <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 f m weather; Inadequate sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name: lern `, -1. Frequency: <br /> Hotel/Motel Business License? es ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Firet�❑County Code Enforcement/Fire E]Other <br /> � �,( <br /> Rooms inspected: LO 0 �S ZL. <br /> Comments: <br /> Tt <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: ''V\ , C I��� Title: a r \ <br /> Environmental Health Specialist: one: LPLageof <br /> EHD 24-01 4-30-12 .S S 3y�k, HOTEUMOTEL OR <br />