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SAN JOAQUIN COUNTY <br /> Pq• �. <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 /> P <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Cc_ YQ.L Inspection Date:p(i S? <br /> Address: I I D /Y /1 so 6 _��K to �� PE:2 ' PR#: � r7'� <br /> Owner/Operator. ff t'-60- 1 Phone: 09) {23 <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: 2(D 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- <br /> F-1 2 functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in 0 V 10('�'k <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. 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 /> ❑ <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 /> protecti n from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Wes ❑ No Company Name: Frequency: 'T i Ce- o— T10 f <br /> Hotel/Motel Business License? es ❑ No t2 3 <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: to <br /> Comments: vi a c`{ w n r\n�C T ' �h i <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Enviro mental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environment Health pecialis . k / Phone: Sy _ ' )0 V Page 1 of <br /> EHD 24-01 4-30-12 fl HOTEL/MOTEL OR <br />