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psi. ! SAN JOAQUIN COUNTY <br /> - v N\ DNMENTAL HEALTH ® SPAR T fV IT <br /> L ` 1868 East Hazelton Avenue, Stockton , CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sigov. org/ehd <br /> oq P <br /> uFoe� HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility :1npection Date: z . <br /> `, a ✓a <br /> Address: <br /> L - 4/1 PR#Owner/Operator ✓ ne: <br /> ❑ Annual Inspection ❑ Complaint Inspection ❑ Consultation InspectionRe- 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 /> 1 Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, /4' . <br /> garbage, combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 2 functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in s <br /> e 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 /> ❑ s 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 Garbaqe Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate4L <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other :;� =7. <br /> f� w <br /> publicly shared s <br /> P aces. <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: Frequency: t <br /> Hotel/Motel Business License? Yes ❑ No � P � /ice <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire [OZounty Code Enforcement/Fire ❑ Other <br /> Rooms inspected: /C491' <br /> Comments:> ek — 4�ae< tom• 0"&� • � r . } ' E. r� . r: <br /> E%oe It".'Y�C�f '�4:. - •O�c'%.•"V5t �z�i ✓ i"L'+ 1-a'Y•7 aQ}L" Gr9 CJ ..lY4 .`fit G.:'/� i`l::-f'��` (�sP..-s•t C` �" Ga -e� t'=^! . ,p <br /> t�6-teva+ ."'.' 9YJ-CYs� +CJ f/'i°Y�^ti v:-rv^'� �!.. ? tr2 �� w�"` . C'e.'i Cz�' BUr .'®' �•%-c.,. C�" .. t`L'r2 ^ s"{:�°i"' :�Jbb <br /> . . a-Lam �t —t.' .fj E...tc. .t-eco ' . ' �S• Ga-G- a //- .b,,j-" c? Lc,-,. z tu .�'t2trC.eg�2 2"`'g` e, ea�^ , ce' ee/• _f'a*.o• <br /> l'G'�' F � 'rvP`: "� ' tv4zo-" ✓ 2G" 0.L 669.x' <br /> All violations in rooms not h1spected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: A Title: <br /> Environmental Health Specialist: Phone: <br /> rc � ^ m �� �� 5 Page 1 of I <br /> EHD 24-01 4-30-12 HOTEL / MOTEL OR <br />