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SAN JOAQUIN COUNTY <br /> x ENVIRONMENTAL HEALTH DEPARTMENT <br /> k. 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:wvvw.sjgov.oro!ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility. pp Inspection Date:) (6 <br /> WOW- '701 dr Si�h'T(' <br /> Address: PE: PR#: <br /> 7 W �v �G T,k;Or? I 2'fO2 s9 <br /> Owner/Operator- l Ph <br /> SyI,�FNI <br /> % I � J k 73—zva o <br /> (RAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection _ <br /> #Units in Facility: ( # Units Inspected: fo 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 /> ❑ <br /> 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash,garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 2. <br /> on- <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 /> ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> 7. <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 <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: Q Frequency: 2 irW& <br /> HotellMotel 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: 4W I, d-! -#:�'(11 ► I D� 2 1'l <br /> Comments: <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspection2iy the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: ` Title: <br /> Environmen al Health Specialist: Phone �(� Page_f { e 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />