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Aq�,y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> H 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Y. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.slaov.org/ehd <br /> FaR`'�4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Inspection Date. Ly -24 <br /> Address: —fir PE: � PR#pZ� <br /> Owner/Operator: • GlJ Phone: 10-4 ,7q <br /> fnrual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: .2 # Units Inspected: 51 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. p, <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- 3057 3�IP31iq-'0, <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <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 /> 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 /> Bedding: 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 /> Z�� <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? Yes ❑ No Company Name: ? Frequency: ,lil,�'� <br /> Ad <br /> Hotel/Motel Business License? .Yes ❑ No I o Jc ' w.. <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: IjI 2 r <br /> Comments: ` 2 <br /> I A roArn- lod, e <br /> 6r 14 qa8 <br /> Y <br /> - iA too 5` q 0 I I g P. 205h2 RY 2-4-t <br /> , <br /> All violations in ro6ms 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 He Specialist: Phone: l� 1 9 Page 1 of <br /> 5 � � <br /> HOTEL/MOTEL OR <br /> EHD 24-01 4-30-12 <br />