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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> tw ►;. 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> `F..... HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility:co 1 t�t �YD -j n t Inspection Date: 0 p, `� <br /> Address: 32,92- W ,p R_Ctj �'v K MQ \� PE:/�'r,'� PR#:O T✓ -1�I <br /> Owner/Opeerator: 1 k pIVOt(,? /\ Q�,.I /_SA. Phone: <br /> �� <br /> 1 t�-I'7 1 V G <br /> nnual 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 /> ❑ 1" 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 /> ❑ <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,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 /> F1 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 /> ❑ <br /> 7' Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways,exits,or other 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 �fv'smo <br /> �( 10. of or inade uate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protec i n from weat er; inadequate sewage or water facilities. 7 ` <br /> Pest control Used?V Yes ❑ No Company Name: Frequency: 01 -MDftMW <br /> Hotel/Motel Business License? Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other <br /> Rooms inspected:12P QJcj �- 20 <br /> Comments: ve" 6NA <br /> Irl I tki I '�:• Qlh <br /> oQ% and m ai�oirAujjna <br /> 11 on' <br /> rLCQjbjMdaLt1j Of tOG <br /> All vi a ions in rooms not inspected must also bd 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 Speci list: Phone: _ UH00' , ~' Page 1 of <br /> EHD 24-01 4-30-12 t v HOTEL/MO EL OR <br />