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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: a <br /> N; 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd, <br /> �;FaR�' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: ` PE� <br /> Owner/Operator: 1 AM <br /> L ( C Phon 1_0 <br /> Gi _ 14 2 _ 1-too <br /> (Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: 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 /> garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 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 /> ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> 3' 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' Beddin : 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. fir' <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack 13�—�mn <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: E Frequency: <br /> Hotel/Motel Business License? N Yes ❑ No J <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 12 �� 2 ,2 Z 2-2 <br /> Comments: A]hov <br /> 'Ao ,� , <br /> 'tr"� 'muke in 7.-. <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received B Title:��� ��, <br /> Environmental Health Specialist: V 1/ 1 �� rt'/y Phone: p j 0 _ Page 1 of <br /> lil ! <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />