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,gguy SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />{ <br />1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />'• V* Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�i HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Inspecti D te: <br />J <br />Address: 9SZd <br />P # <br />N <br />one:0 <br />Phn <br />Owner/Operator: Oeq � <br />14 <br />Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection e -Inspection <br /># Units in Facility: <br /># Units Inspected: Reinspection On or About: <br />The items checked below are violations to be corrected. <br />Room(s): <br />See Reverse Side of this Form for Detailed Summary of Violations and Code References. <br />Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />❑Room <br />1 <br />garbage, combustible items or similar materials. <br />Room Maintenance: General lack of repair or improper maintenance; Broken or non - <br />functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in <br />❑ <br />2 <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, <br />❑ <br />3. <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 />-use) or individual protective wrapping (single -use). <br />Beddin : Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or <br />rEM(multi <br />5. <br />foul matter; Unsafe; Linens not changed weekly or before new guest. <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />6 <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 />❑ <br />7. <br />publicly shared spaces. <br />❑ <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />❑ <br />10. <br />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: C ,& ! Frequency: yv' <br />Hotel/Motel Business License? [A -Yes ❑ No <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: A-_16-7 <br />Comments: /!o�,rj7aWi- <br />All violations in rooms not inspected must also be corrected. <br />All a-' ec ,by the Environmental Health Department will be billed at the current hourly rate. <br />Received By: Title: <br />Environmental Hea SpVialist: Phone: �6 _�Q� f <br />Page 1 of <br />HOTEUMOTEL OR <br />EHD 24-01 4-30-12 <br />