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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.sFgov.org/ehd <br /> P <br /> �%-o ii HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �/ i �^ Inspection Date-OP <br /> Address: � V(` 1 O <br /> `J PE:� � PR#:OZ4.0� a <br /> Owner/Operator: i/ t'►Vf�(1 1�� 11 Phone:i n ol� p._ G Q <br /> �Annual Inspectionl ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection D l 1 <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, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non \ 8 Z St C1 <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 /> ❑ <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 /> F] 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> F-] 7. Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways,exits,or other <br /> 7. 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? [-AYes ❑ No Company Name: no,%r V_ Frequency: ()Y<L' <br /> Hotel/Motel Business License? K Yes ❑ No j ?jQ 2 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement//Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 9 - U 0 2 24 <br /> 00 <br /> Comments: ;1 Z°�V, 51 <br /> v� ty <br /> All violations in rooms not inspected must also be corrected. <br /> All re-i spections by the E vironmental Health Department it be billed at the curr t hourlyrate. <br /> Received By::1H <br /> T11 —Sp <br /> Title: Lwk f <br /> Environmentaecialist: _ Phone: /I V Page 1 of <br /> `f HOTEL/MOTEL OR <br /> EHD 24-01 4-30-12 <br />