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y c 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 . s0gov . or /gehd <br /> e4 ' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> � rFbR <br /> Name of Facility: r� Ae 1� �7 Inspection Date : <br /> Address : !, `� 1 �4 `i VCV— H U4S PR 3 q oaq � <br /> Owner/Operator : �� Ct /t.�l� Phone : � �q a 1 51 <br /> nual Inspection F1 Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : # Units Inspected : " 4 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 /> 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 /> F1Beddin : 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 /> ❑ 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 JAG( <br /> 10 , of or inadequate smoke detectors or fire extinguishers ; Inadequate lighting ; Inadequate <br /> protection from weather; Inadequate sewage or water facilities . � `� 5 to U v`e 4* <br /> Pest control Used ? Byes ❑ No Company Name : y V\ 'I Xz Frequency: <br /> Hotel/Motel Business License? Yes E] No <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 0(v &*:5 qi e QQ Oa 0 JL <br /> Comments : VN\ q vyvM ' ` 1 A191 e \A %i vti <br /> c G C S' WL�.J 1 'r <br /> '0 - •(wo e.A Gw�j <br /> Yllrvo yu 2 ' ' po r t, <br /> yVtgit^cc� 14 C _ l� _ -� livC� <br /> Ml violations in rooms not inspected must also be corrected . <br /> All a-in ction the E ironmental Health Department will be billed at the current hourlyrate . <br /> Received By A A 1A Title : ( CAM t A , <br /> Environment alth iali21LIA41�kw <br /> n� . \ l� + Phone . I> (`�" 1 � IJ�IvI- �., Pa 1 of <br /> EHD 24-01 4-30- 12 Jj�� v HOTEUMOTEL OR <br />