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QAq�l7 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.orq/ehd <br /> lFOR�'�p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: l,Ca - Inspection Dates <br /> Address: 550 V ) <br /> Owner/Operator: ,l_ _ „/ Phone8001`61q5 -7T-3 <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <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 /> T011 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 /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <br /> 2. 1 y -ba 4tA,6 c4-cc4ed <br /> good repair. Walls& Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water l�il_"_e�I i 0 <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> ❑ 3 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 /> ❑ 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. 11 i - CDC,l4_rrogc4,- IK. yoo. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; LackI'1 H- Sw�c' t-o�c 7-v <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate f`I l -ou-flee/ VW-d." 6-0--le-4- <br /> protection from weather: Inadequate sewage or water facilities. S/vw W_ <br /> Pest control Used? 25 Yes ❑ No Company Name: Frequency: <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: 3 0q , 14 .)►-( yi4a . 1446 11-16 1111 <br /> Comments: div p 1'3 ,kk4 1 a GV-Le_ <br /> I Li11- 5yyyy k<z ► n o v �,, 1 yl kit, -les wt-o Ice s <br /> Pwoyh 1 Li - i'ca ,<--1 or o - l <br /> Row► -- t 11q- a�fol <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 /> Received By: 1�7 Title: /I r o� Q �1 <br /> Environmental Heath cialist: aA K f Imo. Phone%vl _ 6� _/ 5oc <br /> Page1of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OIR <br />