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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> �' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov org/ehd <br /> r <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0�` �-� Inspection Date: U'/06 <br /> Address: �+T �`Iwir�� PE: PR#: <br /> Owner/Operator: j rLVI>j19 Mm' Phone: <br /> ❑Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection -NrRe-Inspection <br /> # Units in Facility: #Units Inspected: I 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. Roonri <br /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or impro a enance; Broken or non- <br /> 2 functioning sink/toilet/bath; Lack of hot water. oors: Not clean, roperly covered or in <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 /> ❑ 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. GOGK.I A;ftrs �p <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? j<Yes ❑ No Company Name: ft.0Aj;r t j CV L Frequency: <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 60N,0dLrCV plu .01PC—' Fv4wD Dv71n /Lv/WIT:_S- /N <br /> C7eWWA146: /k,07 6'& (`)7u. fL Gvr of 41vC /Iv1?6#ZEr' ^0 R.vvn Ar <br /> iJoT h )91-a- l7C'CA'0"4v 7K' !lX ve -v' ^'F, Itc `left ^ <br /> /lr 1W VVg017JrlI7 10 0*/T fu- KrW,004br-. 11r 1NDiU97!a0 17%T /1r kk.,,v"9 GticW //1r /ivur/. <br /> jv#71,6 /Loar7 ArH ov <br /> #Vf Xcol),4 P1jN0,,e74a' rN ntEr/L itvvr7v J;,/,r Nv brn adcir. <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: <br /> Environmental Health Specialist: � � Phone: 4/w—q"jv i Page 1 of j <br /> HOTELMOTEL OIR <br /> EHD 24-01 4-30-12 <br />