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Pq� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: PE j P "a4-01 03 Owner/Operator: Phone: nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection #Units in Facility: 1 #Units Inspected: I ID I Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): ❑ 1. Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- E] 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes, water damage, peeling or deteriorating paint; Dampness or excessive moisture in room. ❑ 3 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). Drinking Utensils& Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging (multi-use)or individual protective wrapping(single-use). ❑ 5 Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. ❑ s Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers;Garbage receptacles unclean or in disrepair. 7.❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other publicly shared spaces. ❑ 8. Pest Control: Infestation of insects, vermin or rodents. ❑ 9. Other Nuisance:Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack ❑, 10. of or inadequate smoke detectors or fire extinguishers, Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? WYes ❑ No Company Name: sZ5{- Frequency: Mo Hotel/Motel Business License? Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: 12 Gj I Z(, )2 j Z� f 3�j 13 4 i'3 J I ?Z J l Z 3 Comments: �� Vc� OF 4KS Cos P - All violations in rooms not inspected must also be corrected. All re-inspections b e Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmental Health Specialist: Phone: r `� Page 1 of r EHD 24-01 4-30-12 HOTEL/MOTEL OR