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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.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �f L}Ot/} G}-{l, CKTV] (� Inspection Date: <br /> Address: ' 2-b D CW <br /> AL BLV �I}00W —15n7 PE�40 PR#: O( 401 t1r✓ <br /> Owner/Operator: 0"&E � 'y A� �pl M I iC_2 Phone:n Oq —q6-7 <br /> -9NG <br /> Annual Inspection El Complaint Inspection ❑ Consultation Inspection ElRe-Inspection <br /> v <br /> #Units in Facility: #Units Inspected: Reinspection On or About: <br /> The ife—nWchecked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> ETI , 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 4V 4a. ChQ <br /> 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in ✓_ f VoA f �d <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water ` , 1�'0 <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 /> ❑ 3. 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 /> Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or 5' 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 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? Wes ❑ No Company Name: Frequency: <br /> Hotel/Motel Business License? Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other <br /> Rooms inspected:5iZ 511 5 o9 2J 3(o34- . 3R4.33 -3 <br /> Comments: 3 04 , 2.2 104 V22, <br /> —9moo-.1 f tt.t -ars <br /> I -, V* �j <br /> It 0 <br /> A10voolations in rooms not inspected must al o be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title:A00 <br /> m S I 1 S l ID 0ry)QAC, <br /> Environmental Health Specialist: Phone: . _ f� (� Page 1 of <br /> EHD 24-01 4-30-12 V �J HOTEUMOTEL OR <br />