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SAN JOAQUIN COUNTY <br /> ��"wl .osa ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> "-lei HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: R,kl-w`! Ino Inspection Date: � I Zo f <br /> Address: `/ noti N- wt`' nW W t(1}��}mn q57 PE:�/,�,�, PR#: )Ll t 0 <br /> Owner/Operator: I �L W 1 1F- fir '`ate I v Iv► I ✓ Phone:. —�-"-9X57) <br /> I 10q <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: O #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, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <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 /> ❑ 3 <br /> 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 /> ❑ 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. <br /> Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack Ct CJK< <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection rom weather; Inadequate sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business icense? Yes ❑No <br /> Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected: )0Z 3 joi M5 1 CO 111 110 . <br /> 10 <br /> Comments: <br /> r°M-n u s o <br /> 0 <br /> All violations in rooms not inspected must also be corrected. <br /> All re-ins ections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental Health Specialist: Phone: n /y (� ) it r_ <br /> L "1 7J �rJS Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />