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Pa�l.y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1" ►` 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: at I v VA Inspection Date:4110 <br /> Address: 2l IO '� M/�1 L� II�L ��`i-,\N !1 (�[j2{C PE: L�� PR#:V� <br /> Owner/Operator: O , �1 UU (,J� Phone:11) l -i-ca _"7 r10 <br /> Annual Inspection ❑ Complai Inspection E] Consultation Inspection E] Re-Inspection [ l•r <br /> #Units in Facility: 154 #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. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 2. <br /> 10�-V ,�to nc� w ftrtr� <br /> functioning sink/toilet/bath; Lack of hot water. Floors: of clean,properly covered or in 0 ��� � <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 /> ❑ 3 Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <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 /> ❑ 5 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 /> ❑ 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 CAP-ice <br /> 10. of or inadamLate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate \(VL <br /> protection from weat er; na equate sewage or water facilities, <br /> Pest control Used? ❑Yes ❑ 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: . 12-1 2- .12-6l3' 2� 2�} - �3 Z.Z 311 <br /> Comments: I j I '--3'.j( <br /> p C I -ev <br /> t t CA v Tz c "M i <br /> I violations in rooms not inspected must also be corrected. <br /> All r sec ' s the Environmental Health Department will be b' ted t the current hourly rate. <br /> Received By: Title: <br /> Environmental Ith pe I' ` Phone: Lt6fb ►( Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />