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SAN JOAQUIN COUNTY <br /> z � .Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> �Awl 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> •4��F�R�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of t <br /> D <br /> ti <br /> I <br /> Facility: Inspection Date:y � -z-7'-2-3 <br /> Address: X7/0 <c-G` LQ`� PEl� R# 7, pl`` <br /> Owner/Operator: Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: /9-f #Units Inspected:ZZ, 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- <br /> F1 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <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 /> ❑ <br /> Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> 5. foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ <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 <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection rom wea er; Inadequate sewage or water facilities. <br /> Pest control Used? KYes ❑ No Company Name: Frequency: ~�, <br /> Hotel/Motel Business License? A Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: /3r >3�� N3 SCI ,/ i� La-, Z 7 ZOO l �^ zS�" 3�s' 3_fV 3q 3 <br /> Comments: , 3y/3 33 f . 331 IC <br /> G e r /3-7 1q.5"X_ SA19 <br /> II violations in rooms not inspected must also be corrected. <br /> II re-i s V the Env' mental Health Department will be billed at the current hourly rate. <br /> Received B � Title: <br /> Environment ealth Sp(~cia' Phone: &Q�6 1� Page 1 of <br /> EHD 24-01 4-30-1 / HOTEUMOTEL OR <br />