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�p,gUlN C SAN JOAQUIN COUNTY <br />> art ' •.pG <br />_ & �ONMENTAL HEALTH DEPART' NT <br />1868 East Hazelton Avenue, Stockton, CA 95262-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slgov-orq/ehd <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: L%�() MTC -z- <br />Inspection Date: 0 <br />Address:V ��-� <br />6 A/ tfv/.�� /XCk7CA� <br />PE: <br />7.�1i� <br />PR#: <br />f"ig yo 0 <br />-- <br />Owner/Operator:7� <br />Phone: <br />/,Y' Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: <br /># 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. <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 />Room Maintenance: General lack of repair or improper maintenance; Broken or non - <br />2. <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 />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 />❑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 />❑ 6 <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate I <br />close fitting covers; Garbage receptacles unclean or in disrepair. <br />❑ 7. <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />publicly shared spaces. <br />❑ s. <br />Pest Control: Infestation of insects, vermin or rodents. <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 />❑ 10. <br />of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br />protection from weather; Inadequate sewage or water faciliti ,w> <br />Pest control Used? XYes ❑ No Company Name:/? V /" 1 j Frequency: rJCt <br />Hotel/Motel Business License? Yes ❑ No <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: ZZ ZV Z J y Z/ 2- Z %! 1 j -r <br />Comments: <br />Z/►` cieyiP IWawlre .r/,/K r <br />All violations in rooms not inspected must also be corrected. <br />All re -,inspections by the Env'ronmental Health Department will be billed at the current hourly rate. <br />Received By: - Title: <br />` ` <br />Environmentaf HealthpeciajiW. Phone <br />Nb Page 1 of <br />i <br />ILI <br />EHD 24-01 4-30-12 HOTEL / MOTEL OR <br />