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a�ln SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95202-6232 <br /> p 'K Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. orglehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: s+ PE: � w (Date: <br /> a OD <br /> Owner/Operator: k Phone: <br /> ®' Annual Inspectioh ❑ 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 /> Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, Yr ko <br /> 1 . w� <br /> garbage, combustible items or similar materials. W 6 <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- vv- AX4 ?*Vwi MW <br /> 2 functioning sink/toiletlbath; Lack of hot water. Floors: Not clean, properly covered or in (��4n � �0 d as i - <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 /> ❑ <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 /> F] s 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 /> ❑ 7. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br /> publicly shared spaces. <br /> ❑ B. 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 5 ^ rq <br /> 1D. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Wes ❑ No Company Name: go+- equency: <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code EnforcementlFire ❑ Other <br /> Rooms inspected: L01 La <br /> Comments: <br /> All d. <br /> violations in rooms not inspected must also be correcte <br /> All re-inspections by the Environmental ea epa men wl be bile a e current hourly rate. <br /> Received By: - Title: <br /> Environmental Health Specialist. Phone: Ll/ / _ O 3 Pagel of <br /> EHD 24-01 4-30-12 l�J HOT 'M L OIR <br />