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0—.1. 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 /> FOR�`p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11� I Inspection Date: rj J kno <br /> Address: 2 �� r;Jn�\�11 l"l 1� —1 /1 PE2 V _I PR#: r,� <br /> Owner/Operator: I m lJ Phone: n _43 <br /> n <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: I # 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- av — bow <br /> �( functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 10WI­ 1' kwyl lS my-chat n <br /> J1� 2. <br /> good repair. Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water 21, tOr�� �lov C� <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 /> ❑ Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> 5. foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ <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 <br /> 10. of or inadequat o ce e ec or fire extinguishers; Inadequate lighting; Inadequate OR <br /> protection fro we ate sewage or water facilities. <br /> Pest control Used?Ryes ❑ No Company Name: Frequency: Tyt <br /> Hotel/Motel Business License? Xyes ❑ No 11291)9_� <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcemerrn��t/Fire E] County Code Enforcement/Fire❑ Other <br /> Roomsinspected:� 1 \\b " 1 M , Z1 v <br /> Comments: ( Y fi <br /> EXUivi k M <br /> J�Mm 061 <br /> or- In aw, m o <br /> All violations in rooms not inspected must diso be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: M010�_ <br /> Environmental Phone: Page 1 of <br /> EHD 24-014-30-12 V� HOTEUMOTEL OR <br />