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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.sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: I i h 4,, �� A,t�'Q, Inspection Date �,�n, 19 <br /> Address: O 2 C �, f � Iv�I�T�/�►- ` K M PE:14,� PR#: mo0'5C) <br /> Owner/Operator: .nn�� �t �rNIA )dU l/L��f v Phone:�el _ 9 -1��� <br /> Annual Inspection ❑ Complaint Inspection ❑Consultation Inspection ❑ Re-Inspection (� J <br /> #Units in Facility: #Units Inspected: 3 I Reinspection On or About: N f <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, _V <br /> garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 2. functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in 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 /> Heating:Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> F-1 3" 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 /> ❑ <br /> Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or 5' 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 ❑ No Company Name: 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: I`/ <br /> Comments: <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: ?.� Title: <br /> t ,— <br /> Environmental Health Specialist: Phone: U q_1,j Page 1 of I <br /> EHD 24-01 4-30-12 / � � 4 HOTEUMOTEL OR <br />