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agC.LVIN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> .�ii<oR*� HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: _/ Inspection Date: <br /> Add-res s: Pt�p <br /> ��// PR# A M <br /> U /[!N <br /> Owner/Operator: A ' ` w `, Phone: 1l <br /> Annual Inspecti n ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection .7 <br /> #Units in Facility: O #Units Inspected: 10 1 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 /> El garbage, <br /> 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 /> ❑ 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 /> Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> ❑ 5' foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ <br /> 6. <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 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 rom weather; Inadequate sewage or water facilities. <br /> Pest control Used? A Yes ❑ No Company Name: #- h Frequency: <br /> Hotel/Motel Business License? XYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: -2� 1 f -Z[ D 1 12,,V$ lt 2p j 2-J9 1 ZZ <br /> Comments: <br /> D l l e <br /> All violations in v6drns not inspected must also be corrected. <br /> All re-inspections by the Environmental Health De artment will be billed at the current hourly rate. <br /> Received By. Title. <br /> Environmental Hbalth Specialist: Phone: <br /> .Sr—,�_ Page 1 of <br /> EHD 24-01 4-30-12 HOTFI MOTEL OR <br />