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,,q�,� 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.sigov.org/ehd <br /> a��FORN`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: \r Inspection Date:3 (}I'la LID <br /> Address: a I �1 ]� P�: PR# ,� ;l <br /> 1 , u �. 5 /_ 11 <br /> Owner/Operator: PhoneL200 <br /> t -tt )/ <br /> nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection <br /> - <br /> #Units in Facility: , #Units Inspected: 2, 1 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: LackQf clean' sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> ct'V1J W <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- oil fl( 0 e5 <br /> functioning sink/toilet/bath; Lack of hot water. Floors: ofc ea properly covered or in <br /> 2 good repair. Walls&Ceilings:Walls/ceilings in need of c eaning or repair Holes ater <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ <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 /> ❑ Bedding: 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 /> 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 ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? Xyes ❑ No Q1" ,(D © <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: ,G <br /> Comments: r <br /> UM� r f a �. <br /> � Y L l J t7 Cr 11 D <br /> All violations in rooms not inspected must also be corre ted. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Receivedk/ '1 Title: <br /> Environmental Health Specia st: L Phone: /� f�- lJ' Page 1 of <br /> HOTEL/MOTEL OREHD 24-01 4-30-12 <br />