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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ;Z 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd p HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspect' n D te: Address: �S, / PE A/ LS PR : Owner/Operator: _ i P Z e: X —M11L 7 Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re-Inspection #Units in Facility: d #Units Inspected: 10 1 Reinspection On or About: �If� The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, garbage,combustible items or similar materials. Room Maintenance:General lack of repair or improper maintenance; Broken or non- F-1 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,property covered or in good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness or excessive moisture in room. ❑ 3 Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, working condition; Lack of adequate heat(Standard: 70°F at 3 feet from floor). Drinking Utensils&Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging (multi-use)or individual protective wrapping(single-use). ❑ 5 Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. ❑ 6. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair. 7.❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other publicly shared spaces, ❑ 8. Pest Control: Infestation of insects,vermin or rodents. ❑ 9. Other Nuisance:Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards;Lack ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: olOk7o Frequency: 2 j, Hotel/Motel Business License? ( Yes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ unty Code Enforcement/Fire❑ Other Rooms inspected: 4Zj p G Comments: g fnn Cyd f All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health De artment will be billed at the current hourly rate. Received By: ( n/ Title: Environmental Health Specialist: Phone Pm) 4ta S Page 1 of f EHD 24-01 4-30-12 b� HOTEUMOTEL OR