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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 /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection D te: <br /> Addr ss: NPS/ M PE l PR <br /> Owner/Operator: Phone: <br /> (e-Annual Inspection ❑ Complaint Inspection [—] Consultation Inspection Re-inspection <br /> #Units in Facility: IS —#Units Inspected: Reinspection On or About; Cj <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 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.❑ 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 /> 3. <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> ❑ l 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 /> Bedding: Mattressllinens infested with lice, bedbugs,or other insects; Not free from filth or <br /> ❑ 5' foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> B 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 0)01. -40(6 <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? 54 Yes ❑ No Company Name: Nye S,Con/o Frequency: m vWj <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: -Al 1 <br /> Comments: If) <br /> `S 5. a <br /> 2t I s +1 <br /> " `K <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 i3y: Title: <br /> Environmental Health Sp ialist: Phone: 1 S Page 1 of <br /> EHD 24-01 4-30-12 J HOTEUMOTEL OR <br />