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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.smgov.org/ehd <br /> P <br /> `'FORS` HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: ! P rli 177D it el Inspection Date: 2 2 Q <br /> Address: l l `1Al. W 1 l SOA UAj :Stc)r /l�q 7j, L' PE:2 / PR#:D 2 O 0 [/ <br /> /Y <br /> Owner/Operator: <br /> h/ttG` GAte4 Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: # 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 /> ❑ 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 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 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 /> ❑ <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 /> ❑ 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 /> X,., 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?XYes ❑ No Company Name: G Y Frequency: 7rL/i( c h a -%,,til <br /> Hotel/Motel Business License? Yes ❑ No I -L/3 <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: C I 0 <br /> Comments: _ <br /> X210 'L I C1 ? CG 7 10 } 6-1— 6 Z <br /> aYa e,c_ S j'a S a (cE h -e he-Cn0G> <br /> `t° t^. f -e G ,rZ a- e/L- ' o Ye i,,e <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inApectl4s by the ironmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Heal Specialist: 64. Phone: _ ^ Page 1 of 1 <br /> EHD 24-01 4-30-12 ��S��G�{ HOTEUMOTEL OR <br />