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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> MM <br /> at, •' to <br /> Telephone: (209 ) 468 .3420 Fax: (209 ) 464 -0138 Web : www . sigov . orq /ehd <br /> HOTEL/ MOTEL OFFICIAL INSPECTION REPORT <br /> Q � lkbg�' <br /> Name of Facility : T�(�-,-e� / � `� M e �� C �' q Inspection Date : <br /> Address : n �[J tl , 6L c jA f�j I , •e J'F to h qE PR# : <br /> Owner/Operator: 'e LA) � GGZtti n1A 2 0) 9 2- _ its <br /> nnual spec on ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : �, # units Inspected : 2 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 functioning sink/toilet/bath ; Lack of hot water. Floors : Not clean , properly covered or in <br /> oo�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] Heatin : Lack of approved heating in each unit; Approved heater not maintained in a safe , l � f <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 /> ❑ 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 /> F-] 7 . Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other <br /> 7 . 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 /> NONE <br /> Pest control Used ?.. es [] No Company Name : Frequency: U 10)1 t h f <br /> Hotel/Motel Business License? isees ❑ No 111t# <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 4LO4Z 1, Z. L 3 Z <br /> Comments : <br /> F � Ve L � ��ners 0 c� yy' ' toev " ��- <br /> All 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: CbY, t � �1 Title : <br /> Environmental Health Specialist : l �f `tet Phone : ( y f rj Page 1 of <br /> EHD 24 -01 4-30- 12 � � i,C (� , HOTEL/MOTEL OR <br />