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pq�, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> P <br /> �F R' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: U u V-'"' aW g� MaP» Otf Inspection Date: <br /> Address: 5,2 62. w , ,A Q 1 PE:2 PR#:O <br /> Owner/Operator: Wl"'S Sl�.0 A J U O" Phone:n ,/I_'7� 7 <br /> G T I • � I ©G) <br /> %Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: w #Units Inspected: lei 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 /> 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 /> 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 —I <br /> 10. of or inadPa late smoke detectors or fire extinguishers; Inadequate lighting; Inadequatesn <br /> protection from weather: Inadequate sewage or water facilities. -Oall,24m12f Q <br /> Pest control Used?N Yes ❑ No Company Name:. Frequency: Min <br /> Hotel/Motel Business License? Wyes ❑ No <br /> Multi-Jurisdictional Violations to 6e Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: 2 Z 2 <br /> Comments: '._�J/�-S`R (p1{( `/ �N/ 014 13 <br /> PQDMIS <br /> 1`N O (X opfofe"Im <br /> All violations in rooms not inspected must also be corrected. <br /> All 40 ns ections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmen a pecialist: Phone: rZo ..3 S Page 1 of <br /> EHD 24-01 4-30-12 HOTEL/MOTEL O!R <br />