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U i.y SAN JOAQUIN COUNTY <br /> a�.._,f.F�•.o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �-�,�,� 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> 1' Il�r .' Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> ••�lFOR�`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C O 770 � 1 O C Inspection Date: I f 3 Z 3 <br /> Address: 0 Q{�(/�� U CJ� s� tj n PE:Z7D0 PR#: /000) 0 <br /> Owner/Operator: � Phone: "/ �J _9 -3y'Z <br /> Ef Annual Inspection ❑ Complaint Inspection [:1 Consultation Inspection ElRe-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, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- <br /> F-1 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <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 /> ❑ <br /> 5' Beddin : 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 /> ❑ 6 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. Yoke�''t"�✓u�/ J <br /> El 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack c fUV <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate hl— SWI{(L f lo'f <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? 7yes ❑ No Company Name: L_W Frequency: B <br /> Hotel/Motel Business License? es ❑ No 11 /30 l Z,3 W. <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Ix <br /> Rooms inspected: `L 7.12- Z(9 309 0 0 3C)l IN <br /> Comments: <br /> • _lI ✓� �o�� °ern , re- v <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: (�j, p Phone: Page 1 of Z <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />