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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.sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> -2_2 <br /> Address: PE: PR#: <br /> .1.72- ZqI6_�- r <br /> Owner/Operator: Phone: <br /> ----� Flo eZ nMGd -:�� <br /> nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: #Units Inspected: 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- �/15 l ^'At- <br /> Y 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in 6i 4cv; <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 /> ❑ 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 /> ❑ 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 /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> F-1 6. 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 /> ❑ s. 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 - 7i>- <br /> 10. <br /> i>10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate V/7e <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? t&Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? XYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: r '_;10 <br /> Comments: lel la <br /> &_44,4 a,,ek. Sys it <br /> i e_ f 2 x_3 <br /> / (!C�iz y+I l-ti' C,rL C•: ')' �!i�.�,"►.t'`� '"{G' C',j�`�C[./C.� <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: Title: V`, <br /> ' <br /> Environmental Health Specialist: 1 2 Phone: � `&fir _31 Page 1 of <br /> EHD 24-01 4-30-12 /� lit HOTEL/MOTEL OR <br />