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oPq!!!k c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> J <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FORN HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: RL)o&'Er o Inspection Date: JC, 8 <br /> rntN , <br /> Address: 1 q-5 N �UfL-soy VVI1rLJ, J 7t 4,Kwt�) (� osu5 PE.,, /0 PR#:�2,�oc52 <br /> Owner/Operator: frM74 IK,11 °15rt,131 1 PrOliV i6u w Phone: <br /> Pt-t'p Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: i,I # 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 /> ❑ Room Cleanliness: Lack of cleanliness&sanitation; Accumulation of debris,trash, <br /> 1' garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- /Jr <br /> 2. <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not_Dean, properly covered or in <br /> good repair. Walls&Ceilings Wallsiceilings in need cleanin r repair: Holes, water <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 /> ❑ Bedding: Mattress/linens 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 /> ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> 4❑ 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 i.nadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Ft Yes ❑ No Company Name: Frequency: 6IN1E Hj <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: ,C P 4y /ll <br /> Comments: AtTwILC 06tT 60L,6 ' "IN r£'f7,14e7tJ' 1rV1L <br /> �;- !'14?��aE L1art7 AlLG Gt1vC�,,. <br /> r I — Ct&> N 6M#00tl • Pzf►NT PC-"1LCz7 XfttJ 1v MI�1ci� l�nNl. Guc•o/L . <br /> IO2— r l(,fti fixfit►Lf c:c�r�lf.ECl <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: <br /> AV <br /> Environmental Health Specialist: Phone: q&j.-.1 g-y} Page 1 of <br /> EHD 24-01 4-30-12 4 HOTEL/MOTEL OIR <br />