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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 . s * gov . org /ehd <br /> HOTEL/ MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : �, rr I wa el <br /> Inspection Date : <br /> Address : 2 St . PE : ZII7 PR#: () Z <br /> Owner/Operator: � Col J I cok� Phone : / G ro <br /> Annual 1 spection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : 2 # Units Inspected : S 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- IG �' ' �' K <br /> functioning sink/toilet/bath ; Lack of hot water. Floors : Not clean , properly covered or in 7 k49 ( e 41 Ce r ► t 4t <br /> 2 ' 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 /> ❑ <br /> Heating : Lack of approved heating in each unit ; Approved heater not maintained in a safe , <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 /> F'] Beddin : 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 /> ❑ 6 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 /> 7 . 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 �a 6Sn6 Ke <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? IN es ❑ No Company Name : CjtAVK Frequency: 70 ^ <br /> Hotel/Motel Business License? es ❑ No <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected : 10 1,(} IL 7Z <br /> Comments : <br /> GanJ`�1 <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 : C <br /> 1(2 <br /> ironmental ealth pecialist: , qch O <br /> t ! . iii Phone : q Q ._ <br /> Envs Pagel of <br /> lr 11 J �J HOTEUMOTEL OR <br /> EHD 24-01 4 -30- 12 A7� <br />