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y. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.or /q ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: t <br /> Address: 2 )O �l/ 7,,Kch- '' I. s�a�W� J cS 2 I PE: X11&) PR#:D 2-q O l <br /> Owner/Operator: 1 ��,`,�` Phone: ( To)) 3 9-3—Y <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: t 1�, #Units Inspected: Z ,j 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- K/Vo b <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 3,ss w'`1 eY ^,,q�l feil, - <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. 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 /> ❑ 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 /> rI <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; LackJ3y� <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--Comy_Name: 16(.1) Frequency: y(,�- <br /> TE <br /> Hotel/Motel Business License. ❑Yes ❑ N k iN t..,-� 1✓ot Y ec- i fi ,�C- vL,- <br /> Multi-Jurisdictional Violations to be eerred to: ❑ City Building/Code Enforcement/Fire❑ County Code EnforcementlFire❑ Other <br /> Rooms inspected: u j �CJ J ci_� 3 - -i'<., »_ Z y <br /> Comments: <br /> IS -1 7 D"I 1-56 <br /> eC no Cl r ee e <br /> c c v e- A-C efn r <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspe ' by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Health ecia' c� `'„ C / one- 2 0 (j�— / Page 1 of <br /> J l HOTEL/MOTEL OR <br /> EHD 24-01 4-30-12 <br />