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q� N SAN JOAQUIN COUNTY <br /> ? y ENIONMENTAL HEALTH DEPARTP \JT <br /> "t 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> Telephone: (209) 468-3420 Farr: (209) 464-0138 Web: www.sigov. org/ehd <br /> FSR" HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility. InspectiTe <br /> Address: f , _ • - PE . �'yOwner/Operator PhoneG ,,Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-In <br /> # Units in Facility: g # Units Inspected: Reinspection On or About: y <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 /> T2 .[SRoom 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-functioning sink/toileYbath; Lack of hot water. Floors: Not clean, properly covered or in <br /> e r <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. c - <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 /> tGarbage 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 /> Pest Control: Infestation of insects, vermin or rodents. <br /> . 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 rs or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. 3L 3 <br /> Pest control Used? RYes ❑ No Company Name: tr Fre <br /> P Yi Frequency: <br /> Hotel/Motel Business License? FYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected: o e1`7 �a2 -2 Z `- cd3 3 CAS= -Id <br /> Comments: r ' ° <br /> '� � " ` d^tL . w �-' a9�1— �-�'e 4' <=_ s✓'�-LE,'-' l3u'-Eh f��=.N.r^'_ 44 !^usec-c0'4, 4(f AerGl-e. <br /> psi -,- c°� - _ :, ti � �,. ��� / • <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections b the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: y , * j - Title: <br /> 11 <br /> Environmental HealtfhSpecialist Phone: <br /> A.: ".� d^ Pagel of <br /> EHD 24-01 4-30-12 HOTEL / MOTEL OIR <br />