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Pqy„N SAN .JOAQUIN COUNTY <br /> ;j.co ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.or /q ehd <br /> •4C'F�•R�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �` tri �f' �.Inspection Date: 23 <br /> � <br /> Address: ` PE; PR#: <br /> 2y 1i. L n. �"�" 2LiLot <br /> C7�D'�ZI <br /> Owner/Operator: Phone: <br /> W, 20'-i--L4 12 779 Q <br /> [S Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: j OLA I #Units Inspected: 10 1 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 /> ❑ 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- 5c>_ -�'1��, cIV "Viv"'y' <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in 3 <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 /> Drinkinq 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? OYes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? Ejdyes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: i 0,1� 10Ai ( '�. 2��" J1, Z- <br /> Comments: <br /> M <br /> ec <br /> All violations in rooms not inspected must also be corrected. <br /> All re= i s by the Environmental Health Department wi[L be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmen a ecialist: Phone: c <br /> n ; age 1of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OIR <br />