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UIN 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: �` }�)t Inspection Date: U�' 2k <br /> Address: II 61� clun I`f (� ��o <br /> PE PR#: �L 1 I <br /> Owner/Operrator: Alt /I n p v M VV" I Phone:q O q _ �� _ `� qCl <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection I <br /> # Units in Facility: q #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 /> Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, Oh <br /> garbage,combustible items or similar materials. • 3 Oban VOD YIJ�.�t <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- 54 —Ce.`11►�J <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 7510-1wrl }a <br /> damage,peeling or deteriorating paint; Dampness or excessive moisture in room. <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 /> IFAN5 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.Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or othe a 7. publicly shared spaces. <br /> 8. Pest Control: Infestation of insects,vermin or rodents. C�3VIET Y`� Aldl'19. Other Nuisance:Any other condition which is hazardous to health. rds; LackOther Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazaSOQ,--\\j%4%r510. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? RYes ❑ No Company Name: L_o Ca Frequency: &,/'V "' w4kk_5 <br /> Hotel/Motel Business License? ®Yes ❑ No 0-=f 1 ZU k 2-o 0 <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected:541A 5 -5�2 5 13 5-- ' 0 ' Ll 3' 4 2 <br /> q311 �5 S 31in I <br /> t <br /> All violations in roofns not inspected must also be co rected. <br /> insp t ns by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: f Title: /A' [� / �,N <br /> Environmental Health Specialist: `� Phone: ' 'v C 1--� Page 1 of <br /> G <br /> HOTEL/MOTEL OREHD 24-01 4-30-12 <br />