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o�q y� SAN JOAQUIN COUNTY <br /> �.•. •.o <br /> r.' —�r� • yENVIRONMENTAL HEALTH DEPARTMENT <br /> l <br /> "= 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> 1 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address - '- — PE-0 PR <br /> G✓ / 2 rt�c L r� . j Zt o <br /> Owner/Operator: �D' Phone d `f.77, _9.700 <br /> nnual Inspection ❑ Complaint Inspection [] Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: d #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 /> ❑ 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 /> El 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_ <br /> 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? 09 Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? 0-Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: �/ / j „ f ) 42. 14-3,215- 2 ( 7-21 3 _3 1 <br /> Comments: <br /> 46 <br /> �i• �u -�•cv2 rte- :' <br /> All violations in rooms not inspected must also be corrected. <br /> All re-ins ect s b the Environmental Health Department will be billed at the current hour) rate. <br /> Received By: ` Title: <br /> Environmental Heal Specia..s� t: Phone: <br /> � , ,�• —�c.rj,Z Page 1of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />