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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.slgov.or-q/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: <br /> e1717 104­*t,4"W, <br /> _6_wner/6`pJ_a_tor: ae - <br /> 1! Phone.- <br /> !�,ySXAnnual inspection Fj Complaint inspection ❑ Consultation Inspection E:] Re-Inspection <br /> #Units in Facility: '7 7 #Units Inspected: -7 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 /> ❑ <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 /> working condition; Lack of adequate heat(Standard: 70°F at 3 feet from floor), <br /> TDrinking Utensils&Ice Buckets-Not protected from contamination; Lack of or improper <br /> 04, '1 washing&sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> from filth <br /> 5. <br /> Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free or <br /> foul matter; unsafe; Linens not changed weekly or before new guest. <br /> F] 6. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers;Garbage receptacles unclean or in disrepair. <br /> El <br /> Eublic Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways,exits,or other <br /> ! 1 <br /> publicly shared spaces, <br /> ❑ 8. Pest Control: Infestation of insects,vermin or rodents. <br /> F1 9. i 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? kYes El No Company Name: Frequency: <br /> Hotel/Motel Business License? rN3ves 0 No <br /> LA I <br /> Multi-Jurisdictional Violations to be Referred to: 0 City Building/Code Enforcement/Fire 0 County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 0 / 1 2-G IZ7 F- <br /> 1? 0 , 2-3 o,, <br /> Comments: Ae,I V�h <br /> All violations in rooms not inspected must also be corrected. <br /> AlLre-ins pections by thop Eeironmental Health Department will be 4illed at the current hourly rate. <br /> Received By/ ,/ Title: F 6W <br /> I ZWUM-4"�X' - bo-y__ <br /> EnvironmehtM Ile-alth Sp6c-iaTtst: Phone: age 1 of <br /> EHD 2401 4-30-12 HOTEUMOTEL OR <br />