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pq!!!N SAN JOAQUIN COUNTY <br /> �O.��•cGG <br /> Q: <br /> Er JNMENTAL HEALTH DEPART _ 1T <br /> 1868 East Hazelton Avenue, Stockton, CA 95209--6232 <br /> ` Y. Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: m C'�el Inspection Date: �/�7 j <br /> Address: 6,11 7 �� -., a*�L. ��(. PE 1�IT PR7#,2-Yee `J 2— <br /> Owner/Operator: <br /> Owner/Operator: Phone: <br /> Annual Inspection Complaint Inspection ❑Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: 1�, # Units Inspected: 1-r I Reinspection On or About: <br /> PP- <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 /> 2. , <br /> 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 re air Hole;water <br /> lama , peeling or deteriorating pain ; ampness or excessive moisture In room. <br /> ❑ 3 <br /> 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 /> ❑ 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 /> ❑ 1 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? Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: -yl Z Zf .Z l Zt)le; f <br /> Comments: — <br /> '7 rZ,c,... vw r <br /> All violations in rooms not inspected must also be corrected. <br /> All re-insEtcti2bs by the Environmenta ealth Department will be billed at the current hourly rate. <br /> EEnvironmental&alth <br /> d By: ►� r i Title: <br /> Phone:S eclalist: <br /> P 1� <br /> — "Z Page 1 of <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OIR <br />