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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ••w•�/FOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: o Inspection Date: <br /> Address: S �.` �, JU l�ff-- to` 7 PE:ZT I 1 PR#: O Z y <br /> Owner/Operator: Phone:(2a-) 1 a 0 l�'-006 <br /> Annual Inspection El Complaint Inspection El Consultation Inspection E:1 Re-Inspection <br /> u <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 /> ❑ 1 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- `L03 VCC K <br /> 92. functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in Poo It+;(e <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 /> ❑ 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 /> ❑ 5' 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 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> ❑ 7 Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> publicly shared spaces. <br /> ❑ 8. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack c,. e <br /> rx-to <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. L Z <br /> Pest control Used?14 Yes ❑ No Company Name: Frequency: iTf 1L, <br /> Hotel/Motel Business License? Yes ❑ No I ZZ <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: <br /> Comments: <br /> o N1 S U:1 _ <br /> s h ' e e e 6 V_ iv i ►� e <br /> c-rAe fv" etrn �- Ye4-1��� <br /> All violations in rooms not inspected must also be corrected. <br /> Ali re-inspect n by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: ` �J <br /> Environmental FAh_ pecialist ( , C lel" Phone: Z�7 Sy; _ O r Page 1 of <br /> EHD 24-01 4-30-12 J J HOTEUMOTEL OR <br />