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Pq• A1. <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 /> • •�IFOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: IMd <br /> Inspection Date: <br /> Address: C��t�� ('ALV PE:'L�jv� PR#:Q2 Uol <br /> Owner/Operator: e 2 1 ?(A& Phone: C-7/0-) <br /> nnual Inspection El Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: G, #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 /> 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 improper maintenance; Broken or non- <br /> F-1 <br /> on- A/0 <br /> 2functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in❑ 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 /> ElHeating: Lack of approved heating in each unit;Approved heater not maintained in a safe, i l� <br /> 3. working condition; Lack of adequate heat(Standard:70°F at 3 feet from floor). V u 64r .,� <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 Beddin : 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 <br /> ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection!2m weather; Inadequate sewage or water facilities. <br /> Pest control Used? , Yes ❑ No Company Name: "ti► Frequency: �2I <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: 3 V ci ._ ��;, U` I (; <br /> Comments: L <br /> -ye <br /> e f� Ke 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: <br /> C. <br /> Environmental Health Specialist: 1, Q hone: Page 1 of <br /> EHD 24-01 4-30-12 (/�4l HOTEUMOTEL OR <br />