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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> •` Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: (,•}- y��y� �` t 1�},� Inspection Date: r1 <br /> Address: V ! PE:2��� 4k <br /> Address: <br /> ►fi <br /> Owner/Operator: W i t O h At Phone(41 r7 L <br /> N,Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: ' V3 # Units Inspected: , I 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 /> Room Cleanliness: Lack of a Ii &sanitation;Accumulation of debris,trash, 1� <br /> garbage,combustible items or siml ar materials. <br /> Room Maintenance: eneral lack of re ai r improper maintenance; Broken or non- <br /> functioning sink/toilet/ba ac o of water.Floors: Not clean,properly covered or in <br /> 9 � <br /> X 2' good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water '+�'�, 44 <br /> 9 P g 1� Ib� ' 1 kW �n <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 /> ❑ b 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 /> r❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards;Lack �W <br /> 10. of or inadequate s e or fire extinguishers; Inadequate lighting; Inadequate a n <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? es [] No Company Name:• ' 1", quency: <br /> Hotel/Motel Business License? Kyes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ `City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspected: 1 �v <br /> Comments: , <br /> ' 0-- M ��� <br /> 1 l� - <br /> )LA VP <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: Title: �n j I <br /> f" v <br /> Environmental He pecialist1 C Phone: _ � age 1 of <br /> J HOTEUMOTELOF <br /> EHD 24-01 4-30-12 <br />