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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.s*gov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 113&1<.t t Inspection Date: 6- <br /> Address: . <br /> L PIE PR#: <br /> �, 'T�i,I cY �..A��. <br /> Owner/Operator: LLL. Phone: <br /> �� �Sa.^^/� � u, �, i ✓u i c: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection <br /> #Units in Facility: j ZC # Units Inspected: -Z6 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. <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 /> ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> 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 /> ❑ 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 /> E] 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 <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate 139, 2-34, (v,2Yd/Ly S,zy4 <br /> protection from weather; Inadequate sewage or water facilities. AJ`/ 237. L3�� �� 22;iili, 9,Lac <br /> Pest control Used? RYes ❑ No Company Name: ;L J&k Frequency: <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: 1 3 " 7�• I L ,yl z!Z Z/Y .ZZ y Z3.0 ; u zy ez7 ZL(c z:3i G s c; LY <br /> Comments: ' �� -�.L3u� 3L. <br /> All violations in rooms not inspected must also be corrected. <br /> All rethjspqctiqns by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: f, Title: <br /> 1Pj4v-ts Jck <br /> Environmental Health eci list: Phone: <br /> 2.0f 3W e Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />