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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2.• .—crr- . <br /> k9l 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. j' /Ly Zv�'�) <br /> Address: Q FYI ���G�/��m PE:ZUnq PR#:OSS- ' 2. <br /> Owner/Operator: c L I ►l. Phone: (go)3LfS_16 J�� <br /> Jnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: / Z #Units Inspected: ` I 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 /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- 'pUB-e -%I- <br /> 2. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 311 -OPI ICA L'ct t/va-'cr <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 <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: () V ki 1hA 161Frequency: Py6 -f 1- <br /> Hotel/Motel Business License? Yes ❑ No 3 -, <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 3�,� 3 2y )2 3 <br /> Comments: <br /> ✓e a ^YA3 4,ri(� <br /> WIF reConn . r <br /> All violations in rooms not inspected must also be corrected. <br /> All -inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: uaft)�4Title: ( /� <br /> Environmental Health Specialist I, e' /�/ Phone: Z fpt�"� 6e_- VZ0 Page 1 of <br /> l• `'J HOTEL/MOTEL OR <br /> EHD 24-01 4-30-12 <br />