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SAN JOAQUIN COUNTY <br /> a=" ENVIRONMENTAL HEALTH DEPARTMENT <br /> cFr� 'Gy <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> • •�(FOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: , 1 In2spection Date: <br /> Address: PE: PR#: l/ O 9 L <br /> Owner/Operator: Phone:(� /q) �ZJ3 <br /> Annual Inspection ❑ Complaint Inspection ElConsultation Inspection ElRe-inspection / Z <br /> #Units in Facility: I #Units Inspected: `J I Reinspection On or About: l <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 /> ❑ <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,3. 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 t., x.00 M <br /> 4. washing&sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). Co r4 r-A A � � <br /> ❑ 5' 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 /> ❑ 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. <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? Q Yes [] No Company Name: ^/ r Frequency: r✓r <br /> Hotel/Motel Business License? VYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 't_.,\'2 'L ( I S <br /> Comments: S�(,tt, _ &A)5 ire- G <br /> (-O <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-.k Title: <br /> Environmental Health Specia st: ��� (,_,bbfj�`'` Phone:/LA 0�� '7 b ��. Page 1 of <br /> EHD 24-01 4-30-12 WJ HOTEUMOTEL OR <br />