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4¢Qeln. r 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. org/ehd <br /> 4' • � �FO�H4 • HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �d /(!y/G�('Gca_ Inspection Date 7 7 <br /> Address: ;4?w /,L(/r 1RAfZ'& �+ . � cf¢��, P <br /> Owner/Operator: Phone: <br /> �& ik.i buy L'Z <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: &7z # Units Inspected: 1 b 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 /> El 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- //4'- 69� �1�r,` J' , <br /> z functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 9" T <br /> good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water 749 <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, n <br /> working condition; Lack of adequate heat (Standard: 701F at 3 feet from floor). �� <br /> rT <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 /> El 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 /> El 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? 5d Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? Mes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : ( Z7 Z q //9 / ZZ7 S o(p 9/ ZCP <br /> Comments: <br /> el ! hime. <br /> All violations in rooms not inspected must also be corrected. <br /> All re4poecM29n=2ealth Department will be billed at the current hourly rate. <br /> Received By: Title: / <br /> Environmental Health ecialist: Phone: 2 Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OIR <br />