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,Q�ly 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.sjgov.org/ehd <br /> 4 <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: M a�t►�P /323 Inspection Date::R�. <br /> Address: G 7 f 7 ;P ..� oK� r'�a! PE: D� P fi�2 Dog 1- <br /> ir <br /> Owner/Operator: Ko u�� Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: #Units Inspected: _S'– —(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 /> 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 /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> ❑ 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 <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 /> Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or s. 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 /> ❑ <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? ❑ Yes XNo Company Name: Frequency: AWo <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: /� ZZ j 1 7-1 <br /> Comments: ij/ <br /> e!b - d(/ L <br /> All violations in rooms not inspected must also be corrected. <br /> I re-(n ec io the Environmental Health Department will be billed at the current hourix rate. <br /> Receivedy: Title: <br /> Environme <br /> tall ealth ecialist: Phone: <br /> •` Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />