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�rE <br /> atbo,!v rr. SAN JOAQUIN COUNTY <br /> a .. �•.o <br /> `z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ''•" Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: s ocmo -4 r Inspection Date: YA'�ZZ <br /> Address: e. /c/ PE: PR#:O�(��/,1� <br /> Owner/Operator: �l Phone: UdYyz_ V <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: L' I # Units Inspected: 17, 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, n o <br /> garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- F,o <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 /> ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> 3' 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 /> ❑ Beddin : 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 /> ❑ 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. r Z <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack i7(1� �t / <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: V Frequency: <br /> Hotel/Motel Business License? 'J;�Yes ❑ No i <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: �Z " 'C 2 rZ •3 ,S r L Z Z <br /> Comments: <br /> flvc il 'h -1-sh(f V-5 h ✓ <br /> A - �✓ .� f. <br /> ranner o ' �✓ <br /> 0�c fL�" t <br /> Alf violations in rooms not inspected must also be corrected. <br /> All re-inspecti s by4e Ery- ' onmental Health Department will be billed at the current hourly rate. <br /> Received By: I N1 Title: <br /> Environmental alth Specialist: ( C /- mi e: ? ) `�, Pagel of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />