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o;'.CA !rr. SAN JOAQUIN COUNTY <br /> a 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.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1,I— Inspection Date: Z <br /> L'6 aut Z <br /> Address: ! L � PE:JADCA <br /> Owner/Operator: r _ Phone: <br /> Annual Inspecti6n ❑ 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. ►our=Sink. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- L 35l'7_A9'1 z 3 11 L Z, 741 <br /> 2 functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in '�31�1231 221 <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 /> F-1 3. <br /> 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 /> F-] Beddin : 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 /> ❑ 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: �,(-fs Frequency: qtr <br /> Hotel/Motel Business License? XYes ❑ No \1 - °Z <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Buil ing/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: ZCkw L 1+ 1 <br /> P I �3 ' �h L, 2_ " Z �'SI 25 2 1, �{2 t <br /> Comments: t I ,� ; , 2 Id i <br /> •2tp`.\tK�cli I�5 31 2 . . <br /> i ' °� s •Z4 4 Circ &1i i n Q t4- i W <br /> All violations in rooms not inspected must also be corrected. f q(t� <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. - :� <br /> Received By: �.._ CTitle: J/�' U/ b � z <br /> Environments ealt pecialist: Phone: Pagel of <br /> L 16 <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />