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pgo�l SAN JOAQUIN COUNTY <br /> y! °2 ENVIRQNMENTAL HEALTH DEPARTME . . <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. orp/ehd <br /> .�q C%FOPN`p'• HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: <br /> ev <br /> 2,y4l`f" . /✓rt.s,-•c,L�.- &eL • PE;r���0 j p-52. / { 2 'f <br /> Owner/Operator: Phone; <br /> EkFz wfec4 Fc C f it 72 . <br /> Bb%nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected : (p 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 /> F-1 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- <br /> E] 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 /> ❑ 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 /> ❑ T 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? es E] No Company Name: L'� , Frequency: lVas i <br /> Hotel/Motel Business License? VYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 2 X17 2 1 S e Z9 <br /> Comments: <br /> a <br /> All violations in rooms not inspected must also be corrected . <br /> All rein tions by the Environmental Health Department will be billed at the current hourIX rate. <br /> Received By: Title: ' t ' <br /> Environmental Health Specialist Phone: 19 /'r C�., � / - -) Page 1 of <br /> EHD 24-01 4-30-12 `GS `t""-� HOTEL/MOTEL OIR <br />