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SAN JOA UIN COUNTY N N ANT I�_H,, EALTH ® EP ® f Stockton , CA - Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www, sigov. org/ehd 'uFOR�` HOTEL/MOTEL. OFFICIAL INSPECTION REPORT Name of Facility: ` Inspection Date:7 Address: PE ; PR# Owner/Operator: Phone: 'Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: # Units Inspected : I 1� Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room (s) ; ❑ 1 Room Cleanliness: Lack of cleanliness & sanitation ; Accumulation of debris, trash, garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- ❑ 2 functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water damage, peeling or deteriorating paint; Dampness or excessive moisture in room . ❑ 3 F ck of approved heating in each unit; Approved heater not maintained in a safe, ndition ; Lack of adequate heat (Standard: 70°F at 3 feet from floor) . ensils & Ice Buckets Not protected from contamination; Lack of or improper ❑ 4. sanitizing after each use (multi-use); Lack of or improper protective bagging or individual protective wrapping (single-use). ❑ 5 attress/linens infested with lice, bedbugs, or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. ❑ e Garbage Receptacles Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair. ❑ 7 Public Areas: Unsafe or unsanitary conditions in kitchen , hallways, stairways, exits, or other publicly shared spaces. ❑ 8. Pest Control: Infestation of insects, vermin or rodents. ❑ 9. Other Nuisance: Any other condition which is hazardous to health . 2Z Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack 0, S t Awe � fsd ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate ® � h protection from weather; Inadequate sewage or water facilities, Pest control Used? UrYes ❑ No Company Name: L4 Frequency: N 9eti / Hotel/Motel Business License? ®' Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement W ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : 104C f!® Pl dl �!� X63 ® 3 /1 gl ? Comments: ,e e� wzSke r ZiS 132 i All violations in rooms not inspected must also be corrected. All re-Inspections by the Environmental Health De artment will be billed at the current hourly rate. Received By: J Title: Environmental Health Specialist. Phone: Page 1 of EHD 24-01 06-04-10 HOTEL / MOTEL OIR