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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .Z <br /> PC <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> P <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,� n O I Inspection Date: <br /> Address: ( —� —TV) O\! -I Q <br /> 50� PE.aL, 5 PR#a�ow� <br /> Owner/Operator: Jp /el/ v_� � n' Phone a09 -9—7 5�_O�1—_'P <br /> Annual 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- a0, j7wF CaAA4kl Vj�+ <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in a„lv a J 741_ oM M(J Sr <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water �� yt j,�y;nom <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 /> 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 /> ❑ s Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair, <br /> ❑ T 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 ao <br /> X10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate -5✓'''�14� -- &hv" �'Yvcpe� <br /> protection from weather; Inadequate sewage or water facilities. o- nad 5nvokz <br /> Pest control Used? ' <br /> Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? D<Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: Dn , ic . <br /> Comments: �- <br /> j'YL <br /> C� bL . <br /> J M i <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections bV the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Hea h Specialist: ° a Phone: _5Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />