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oAq i, 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.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: L c r4 a m ..t <br /> gr"`D lr�(- Inspection Date: <br /> /1 <br /> Address: 5% ' `, U- D v� � J+ C-T PE: L PR#:0 / ` ®1Q- <br /> Owner/Operator: PRA n 6� �,� /� Phone:, _4-1,��,2-q <br /> nnual Inspection El Complaint Inspection ❑ Consultation Inspection [:] Re-Inspection <br /> "I <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 /> ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance: General of Lepair or improper maintenance;Broken or non- �Adi 1�1102; <br /> �( <br /> 2. functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in Ciom v <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 /> ❑ s 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. "1" <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or <br /> J plumbing; hazards; <br /> dus; Lack t9��.Vllllfte_ <br /> c <br /> 10. of or inadequate s tectors or re extilngusTers; inadequate lightingatel P <br /> Wq <br /> protection rom wea er; Inadequate sewage or water facilities. j4(KLg - <br /> Pest control Used? VYes ❑ No Company Name: cy: <br /> Hotel/Motel Business License? XYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected' iZ Oe) ( Vcl,flnal Cleaftri Dko . 3))3 30 <br /> Comments: f0il MUM YM, SM �t Q nv O/V C , <br /> LWMvalt <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections, by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: -- Title: <br /> Environmental Health Specialist: Phone: <br /> Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />