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o,q�l>Y SAN JOAQUIN COUNTY <br /> .y <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: gt!d0 Inspection Date: `D <br /> Address: /o7S- �` b �,/� PE ,L�� PR#�Z,GOOSZ <br /> Owner/Operator: lam" Phone:: ll%% T <br /> alp <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ -Inspection _ <br /> # Units in Facility: #Units Inspected: Reinspection On or About: V4 hN <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- <br /> 2. <br /> on- <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 /> ❑ <br /> 3. <br /> Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,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 /> ❑ <br /> Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or 5' foul matter;Unsafe; Linens not changed weekly or before new guest. <br /> ❑ s 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 <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? &Yes ❑ No Company Name: Frequency: w( <br /> Hotel/Motel Business License? Kes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other <br /> Rooms inspected: 1p /g <br /> Comments: <br /> NIP �/! �'✓ <br /> All violations in rooms not inspected must also be corrected. <br /> All y-o4irspections by the Environmental Health De artment will be billed at the current hourly rate. <br /> Received By;aw Title: <br /> Environmental F441th Specialist: Phone: &_ZLPaLgeiof <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />