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Pq�,y SAN JOAQUIN COUNTY <br />got cc ENVIRONMENTAL HEALTH DEPARTMENT <br />U): 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />1'� ''1 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.or /q ehd <br />P <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: :` ¢ /4 \j� jl -V- �j it <br />�I�vv, <br />Inspection Date:Awo <br />7�I <br />2�r3 <br />Address: �I.�V1' <br />9 <br />PE ` <br />P <br />Owner/Operator: 1(?(�, �/ ' ,'� I <br />Phone: ,N ,; /` __ <br />`t <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 />❑ <br />Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />garbage, combustible items or similar materials. <br />on-ln1' <br />Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br />in . <br />Y� �Ir 1S <br />2. <br />2 <br />functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or <br />35 - M craw <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 />❑ <br />3. <br />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 />❑ <br />4. <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />❑ <br />5 <br />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 />❑ <br />6 <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />close fitting covers; Garbage receptacles unclean or in disrepair. <br />❑ <br />7' <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />publicly shared spaces. <br />❑ <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />r <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />33 5— (jet(A)r <br />10. <br />of or inadequate smoke dete�r9 or fire extinguishers; Inadequate lighting; Inadequate <br />1Y,& <br />protection from weather; ?n6quate sewage or water facilities. <br />Pest control Used? XYes ❑ No Company Name: Cj`n1 Frequency: <br />Hotel/Motel Business License? .[S Yes ❑ No " ' �, �i' <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: <br />n �0 <br />Oe ems` O 1L G Y . <br />mill hit t2M Ul i <br />Ir <br />r� i<aje l ""w <br />All violations in rooms not inspected must als6 be corrected. <br />All re -ins ectins by the Environmental Health Department will be billed at the current hourly rate. <br />Received By: /� Title: <br />Environmental Health Specialist: Phone: 2 Page 1 of <br />EHD 24-01 4-30-12 \ HOTEL/MOTEL OR <br />