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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> H- 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd. <br /> 4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C r rd t r 1 of Inspection Date: if? 2 <br /> Address: .t C ar Q �J PE: PR#: <br /> Owner/Operator: T.i-Sci,do� a r e-55 { �1 Phone: 2 U q _ ®v <br /> Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: a1 1 # Units Inspected: f 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 /> 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 �i� �fir.,(_ _�'V�"J, , <br /> damage,peeling or deteriorating paint; Dampness or excessive moisture in room. 1 <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 /> F-1 5 <br /> 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 /> rF-1 <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 T-A Z 6W <br /> protection from weather; Inadequate sewage or water facilities. <br /> itao 15 <br /> Pest control Used? K Yes ❑ No Company Name: ► I;, Frequency: <br /> Hotel/Motel Business License? Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Buildin /Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: L 2 Z Z7i "'L':' <br /> Comments: 41 <br /> _ ti <br /> PQM <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspbcVgns by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Heath Specialist: Phone: /� _ ( 2 Page 1 of 201 G i ' <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />