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` AgU1N, <br /> 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 /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: O Inspection Date: Z Y!CO <br /> Address: PE: Z`1IS PR#:pZgCW <br /> Owner/Operator: Phone: / Y _ 01.3 0 <br /> IX Annual In pection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: #Units Inspected: 2, 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- Wp1 4ce,,„I <br /> 2. M��w X21 <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in toss&l veady?" <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 /> F-1Heatin : 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 /> ❑ 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 Sry Ke e-4--e c+-OV <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate n <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name: n.% Frequency: 1/1 <br /> Hotel/Motel Business License? ❑Yes X No k r Q k <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: L <br /> Comments: • c� IN.I(✓ ,0'-q M SMULCZ, 1✓ C for i rh.e(_ <br /> Vdvn <br /> `Fwd w �� 21 ��vC h�se-�C o�.� q,-,s j- <br /> • u r� �n eess <br /> lit e V:3 C C0"'TiVn )e- 'c '70 -7,Z' <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: ` I Title- <br /> Environmental Health Specia ist: �U) 59 9-0C Page 1 of <br /> EHD 24-01 4-30-12 t�u,, y C HOTELIMOTEL OR <br />