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P ly SAN JOAQUIN COUNTY <br /> 'oV*w c°446 ENVIRONMENTAL HEALTH DEPARTMENT <br /> N; �.... X1868 East Hazelton Avenue , Stockton , CA 95202111,6232 <br /> t • 4 Telephone : (209 ) 468. 3420 Fax: (209 ) 464-0138 Web : www . sigov . org /ehd <br /> HOTEL/ MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : Insp' 00ectio te : <br /> Address : G) V G 1` V � � �i �� - 1 1 "✓ P ��i CR 0 <br /> Owner/Operator: Qp.KJ J ' V) y t 23 <br /> [A Annual Inspection ] C,\omplaint Inspection ❑ Consultation Inspection ❑ Re- 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 /> ❑ Room Cleanliness : Lack of cleanliness & sanitation ; Accumulation of debris , trash , <br /> 1 ' garbage , combustible items or similar materials , <br /> Room Maintenance : General lack of repair or improper maintenance ; Broken or non- <br /> functioning sink/toilet/bath ; Lack of hot water. Floors : Not clean , properly covered or in <br /> 2 ' 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 /> ❑ 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 /> ❑ Public Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other <br /> 7 , 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 — 11 ISS 1 a � r <br /> 10 . of or inadequate4smq e e e tb�T or fire extinguishers ; Inadequate lighting ; Inadequate t G <br /> protection from weather; Inadequate sewage or water facilities . <br /> Pest control Used ? CK Yes El No Company Name : Z Frequency: n <br /> Hotel/Motel Business License? f�( Yes ❑ No (b ?, 26 <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 10 I ZZ L ► L o 2 02. 1 O (i � Cl 3 <br /> Comments : ' Movie , C L <br /> All violations in rooms not inspected must also be corrected . <br /> All reminspWions by the Environmental Health Department will be billed at the current hourly rate . <br /> Received By : Title : M , <br /> Environmental He Ith p cialist : _ Phone : 7i I Page 1 of <br /> 1 U HOTEUMOTEL OR <br /> EHD 24-01 4-30- 12 <br />