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SAN JOAQUIN COUNTY <br /> _, �z ENVIRONMENTAL HEALTH DEPARTMENT <br /> �'= 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> •�%FOft�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> L f'(� �. /J-{�, /h Inspection Date: Z//rl-10 Z <br /> Address: 2 S � rLlw"zj,)' ��BCX�tO'�'' PE:`.� PR#: ZyOZ S <br /> Owner/Operator: C"�C M/(J ! ���V VCr� Phone: _ y300 <br /> Annual Inspection f❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: f #Units Inspected: I 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- l Lb jz,, (e i , <br /> 2' <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in Fa <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 /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> ❑ 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 /> ❑ 5 Beddin : 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 <br /> ❑ 6' 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. Lf <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack 614,A- 21.1 (¢'00 4rk' <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate Ca {*e <br /> protection from weather; Inadequate sewage or water facilities. 14 Snz;4e A_e+r%vV f.Weda'l <br /> Pest control Used? Yes ❑ No Company Name:A__ Frequency: T'0_,+k 1Lf <br /> Hotel/Motel Business License?,KYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: ^ L-A- /L <br /> Comments: <br /> Q,F W ,F t�►� ( vec K t e�� <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections bthe Environmental Health Department will be billed at the current hourly rate. <br /> Received By: J Title: <br /> Environmentar Health Specialist: P S0 Phone: IZU� �9g— 00 Page 1 of <br /> EHD 24-01 4-30-12 /' ( HOTEUMOTEL OR <br />