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ap4u''� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> is 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: Z-3 D L ��` PE:-2U 1& PR#SO3 2Z. <br /> Owner/Operator: IL <br /> M Lf w_ l Phone:6b <br /> Vi 14 <br /> Wrinual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection !7� <br /> #Units in Facility: # Units Inspected: 1 Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summa 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- M vv\ 1N <br /> 2. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in PA— 5 vv <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water Tv4 ''A s^xg' <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, V1." <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 /> ❑ 6 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 /> ❑ <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 YL.W% <br /> 10. of or inadequate smoked ors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weat er; Inadequate sewage or water facilities. <br /> Pest control Used? S 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: Z <br /> Comments: �,M �J , , <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections a Environmen a eal h De artment will be i e e current hourly rate. <br /> Received By. Title: <br /> Environmental Health Specialist: Phone: q/ g ©3� 9 1 <br /> —L b Page 1 of 1 <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OR <br />