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U >YSAN ..JOAQUIN COUNTY <br /> op q . . . . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> m . . . _ < <br /> ..,� 1868 East Hazelton Avenue , Stockton , CA 95202 -6232 <br /> " Telephone: (209 ) 468 . 3420 Fax: (209 ) 464-0138 Web : www . sjgov . orq /ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : � ,r Inspection Date : <br /> Address : Z /� L5q <br /> tt�� Gt 11" � 1,L ton PE : Z yC1� PR# : a 2 7 L/ ZS <br /> Owner/Operator: ` 1 Phone : 7 <br /> ❑ Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re- Inspection <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 /> ❑ 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 /> ❑ functioning sink/toilet/bath ; Lack of hot water. Floors : Not clean , properly covered or in <br /> 2 ' 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 /> 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 /> Drinkinq 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 /> ❑ 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 - ) 3 j 133 <br /> 10 . of or inadequate smoke detectors or fire extinguishers ; Inadequate lighting ; Inadequate � ,�, r � f e� crnS - � <br /> protection from weather; Inadequate sewage or water facilities . <br /> Pest control Used ? nYes ❑ No Company Name : vy 'rCr <br /> mf n Frequency : 77V <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 : 2 1r 33 6 Lj ZZ <br /> Comments : <br /> W recon R emyk To )r m •>n L4 , L' TA 7 <br /> All violations in rooms not inspected must also be corrected . <br /> All i ection by tjmk Environmental Health Department will be billed at the current hourly rate . <br /> Received By : Title : <br /> Environmental Healthpecialist : 't!1 � G /� J Phone : LOA „ S Q Page 1 of <br /> !L <br /> EHD 24-01 4-30- 12 HOTEUMOTEL OR <br />