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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.sigov.or /q ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: II Inspection Date: <br /> Lp'L <br /> Address: Z u PE: 2–`1 oq PR#:O uI 0 (,(4 <br /> Owner/Operator: 4KO-4ey Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: / y #Units Inspected: Q 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 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 6'c"TZ <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water Z�3:�4,��ia0.►�[p,%;� <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. Z�pg; h4, �hti <br /> ❑ 3 Heatin : 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 /> ❑ <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 /> ❑ <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? X Yes ❑ No Company Name: Frequency: v„ <br /> Hotel/Motel Business License? KYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected:jD L,Po3 7AjZ'7z•ZV3 .7// z Sia, sr 37o sal s�3 _ 3"3 <br /> Comments:Al �f $, 5-i tl S'�-2Li 6 ,, �i�. S/855-Z"7, ,p ; <br /> /7, 5 �� 5Z+7, 6, SZ� <br /> %�-1�e- �C 7!N d!J/�`1 Gr • <br /> PIC #adr en2�x � <br /> CCS.N O�tc /1W Prowl <br /> ,. All violations in rooms not inspected must also be corrected. <br /> All rl pect by the Environmental Health Department will be billed at the current hourly <br /> /rate. <br /> Received By: Wv""a Title: f'!� N Dr(— i� N���t12. <br /> Environmental Health Sp cialist:A�lft4A ,�h, Phone: �V��. 1(� 3D/8' Page 1 of <br /> EHD 24-01 4-30-12 �U HOTEUMOTEL OR <br />