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Aquly SAN JOAQUIN COUNTY <br /> xR- ENVIRONMENTAL HEALTH DEPARTMENT <br /> iw; < 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �4 <br /> FO �' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspectio D te: <br /> LA QAA 11y 1 <br /> Address: PE: PR#: <br /> 2=�/Gt-[.c, Maw Z"M syc_ Z�k el- 2t0 I I I <br /> Owner/Operator: Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ e-Inspection <br /> #Units in Facility: #Units inspected: /a 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 /> ❑ 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 /> on- <br /> 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 /> ❑ s 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 /> ❑ s 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: £Cnt Frequency: y <br /> Hotel/Motel Business License? ®Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: �� ,' -f 2 Z3 1 31 . <br /> Comments: I'-- <br /> All <br /> tAll violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: E �/c V, L." Title: t/ <br /> e ip, <br /> n <br /> Environmental Health Specialist: Phone: Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />