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Pgvl� 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:wvt,w.sigov.orq/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: f C� Inspection Date: t I l S <br /> Address: Z'gr 4 Ll LA.) <br /> Owner/Operator: Esl�" �C7tJ��ll b LLL Phone: I <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: CX-L— # Units Inspected: Reinspection On or About: <br /> iVA- <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- R w1.30,4- — P <br /> 2 functioning sink/toileYbath; Lack of hot water. Floors: Not clean, properly covered or in wa+ra+ <br /> good repair. Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water epf-- <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ <br /> 3. <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,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. i <br /> ❑ <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 0. 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? Dd Yes ❑ No Company Name: Frequency: <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: Lf ZALI ZZ'Z Z'Z d v $ 30 1130 <br /> Comments: <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 Title: <br /> Environmental Health Specialist: Phone: Lf <br /> v L'_ 3; .3 <br /> � Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />