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JAUVII 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.sigov.org/ehd <br /> •••�IFOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: 12-M3 244k,J-X B l✓.-I PE: PR#: 0Z#61eC3 <br /> Ow er Operator: A zt�,1i )� l// v, 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. <br /> on-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 414ul <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 /> ❑ Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> 6. 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. <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? 29 Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? [K Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement]Fire❑ Other <br /> Rooms inspected: ZZ,3 �Z� •Z2 Z�-�, LZ-S,� Z3 z Z 2 i 3� Z <br /> Comments: kk- t� , <br /> cr.-- 6c�1 .SLS► �.- / �l / <br /> " •ZZ� /:')'Ali� � ' �.�'t���,+ r ��firf/`OY /� 'L�l�� CTG�s�• � f <br /> �Z /tom S /et�i' T * i►. �c. �!C A?X <br /> � � ��,tiG c®v:�►i _ , � n `,�' /fir/�0 l-� =��i�-�uJ :��f'�` �� <br /> All violations in rooms not inspected must also be corrected. �•t�F� <br /> All re-inspectioWby tAV Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: CIAk/ <br /> Environmental H46afth We6iNisf: - Phone: <br /> /t✓!`1�1�'�" � 24jA 6.. Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />