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o�a�lk 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.sogov.org/ehd <br /> `'FORS HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C-1` _+6Y\ Inspection Date: Q /� /,2 C, <br /> Address: 3 PE:�jL,p PR#:OZL4-()1I� <br /> Owner/Operator: M s �'VC t Phone:gZ 1 <br /> Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection 1 7 <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- <br /> F] 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly 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 /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, 9V 0 <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 /> ❑ s Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers;Garbage receptacles unclean or in disrepair. <br /> 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 from weather; Inadequate sewage or water facilities. <br /> Pest control Used? s ❑ No Company Name: Frequency: <br /> Hotel/Motel Busines License? Yes ❑ No IOZV li /Z 6Z3 <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other <br /> Rooms inspected: <br /> Comments: —2-S ' <br /> 2 <br /> [ "( is C ` cke <br /> C n l ' <br /> All violations in rooms not inspected must also be corrected. <br /> All re-i nsp4ctIqAs by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: '-C <br /> 1 II I <br /> Environ ealth Sp ialist: Phone: 2 CYJ t -- �- -- Page 1 of <br /> LN <br /> , l l <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OR <br />