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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPAR-rMENT <br />W <br />1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />WI <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br />w -gov.org/ehd <br />HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Inspection Date: � <br />_�LW <br />1. 7- <br />Address: <br />:5 <br />P E: 2.,q <br />R#- <br />Owner/Operator: <br />Phone: <br />JaAnnual inspection Lj Complaint Inspection [-]Consultation Inspection D Re -Inspection <br /># Units in Facility: # Units Inspected: TReinspection On or About: N Pi5 <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 />El 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. ;li 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 />F <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-1 <br />Bedding: Maftress/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 />F-1 <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br />6� close fitting covers; Garbage receptacles unclean or in disrepair. <br />❑ <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />7. <br />publicly shared spaces. <br />F-1 <br />8. Pest Control: Infestation of insects, vermin or rodents. <br />El <br />9. Other Nuisance: Any other condition which is hazardous to health, <br />❑ <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. it <br />Pest control Used? fqYes F I- <br />] No Company Name: yVtm4&�ffrequency: MCA& <br />Hotel/Motel Business License? [] YesE] No V 0 <br />Multi -Jurisdictional Violations to be Referred to: 0 City Building/Code Enforcement/Fire ❑ County Code Enforcement/FireE] Other <br />Rooms inspected: l-1 . f. . Z_ <br />Comments: <br />V <br />c?sU- itc:Peloid65 AA.,_ eZ(XrAi,_ -1- :5rAAtt16AA,r <br />All violations in rooms not inspected must also be corrected. <br />All re -inspections- y the Environmental Health UDepca- nu must <br />r I t <br />T �Ie 50 ra theUrrent hourly rate. <br />Received By: f Title: <br />Environmental Health SpeFialist: Phone: c6— 0 -3 Page 1 of <br />EHD 24-01 4-30-12 HOTEUMOTEL OR <br />