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0.P4u I <br />fi.• .�iF'•.OL <br />a.• aj <br />V, I X <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />I nsl �-� /JS <br />1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: - Ue <br />r <br />Inspection Date: <br />.Ji <br />Address: ' 1502, a '�o Cx& 9-,' <br />J� <br />PE: ZY� <br />PR#:Q Zyo <br />1 <br />Owner/Operator. �Tl ( - h� , <br />Phone:! <br />nnual Inspection Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: 3 <br /># Units Inspected: S <br />1 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. <br />Room(s): <br />❑ <br />1 <br />Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />garbage, combustible items or similar materials. <br />2. <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 />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 />❑ <br />4. <br />Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper <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 />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />❑ <br />10. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <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? AYes ❑ No Company Name: 0171 <br />Hotel/Motel Business License? El Yes ❑ No • , - - ' <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcemenVFire bRtL d nforcemenUFire ❑ Other <br />Rooms inspected: Q <br />Comments: r O 4l "U ' <br />• F11 If V o See Y -v -•e to - c -k &L i( <br />• S'� M z ��-�" i it e e S e to r i <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 />/ <br />Received By:An #07 <br />Environmental ealth peci list �� �,f i Phone: a —� y� <br />Page 1 of <br />EHD 24-01 4-30-12 //� .I // HOTEUMOTEL OR <br />