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opo ' y ..�o SAN JOAQUIN COUNTY <br /> — ' ''y N \ DNIVIENTAL HEALTH EPARTN IT <br /> ` ` 1868 East Hazelton Avenue , Stockton , CA 9520E-6232 <br /> Telephone: (209) 468-3420 Fax, (209) 464-0138 Web: Ammsigov. orq/ehd <br /> 4G1FOR� HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Inspection Date : <br /> p — ' <br /> Address: PE <br /> a - PR#: ,. <br /> Owner/Operator. gg - Phone: , <br /> ❑ Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Q;18e- Inspection <br /> # Units in Facility: # Units Inspected : i-_ 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 /> ❑ 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 /> functioning sink/toilet/bath ; Lack of hot water. Floors: Not clean, properly covered or in ° ^ ® <br /> 2' good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water { `L ` ` <br /> J : <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ s 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 /> ❑ 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 . <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 cvv— or-,4 <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? [ Yes ❑ No Company Name: E< ;Jn Frequency: <br /> Hotel/Motel Business License? [ , Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: rKCIty Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected: /:98 gz S :S�i ' j i <br /> Comments: /,:P,? pv'� av may:- -- .s F _ «actGf% GDS <br /> fee <br /> r C � = rocs r <br /> r/fig,;.-fCt`.•" %�Z�sy9 ' �'-'PsE� � .��,' <br /> AlVViolations in rooms not inspected must also be corrected. r <br /> AlVre-inspections .by the Environmental Health Department will be billed at the current hourly rate. <br /> Receiv dBy: ,y j' °'"': Title: <br /> Environm ntaf-H a SpecaIi t: / Phone Page t of <br /> . L " g i <br /> EHD 24-01 4-30-12 HOTEL / MOTEL OIR <br />