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Pq� ly SAN JOAQUIN COUNTY <br /> �o. .co ENVIRONMENTAL HEALTH DEPARTMENT <br /> N . . ZWA <br /> 1868 East Hazelton Avenue , Stockton , CA 95202 -6232 <br /> o' Telephone: ( 209 ) 468 -3420 Fax: (209 ) 464-0138 Web: www . sigov . or /q ehd <br /> q4% i aR�' HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility : Inspection Date : 4W5 / i <br /> P <br /> Address : � �� Arch Z � <br /> PE : <br /> Owner/Operator: Phone : <br /> nnual In pection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection <br /> # Units in Facility : ZZ # Units Inspected : Reinspection On or About: 2� Z <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 , Ol Gf LI <br /> 1 ' garbage , combustible items or similar materials . <br /> Room Maintenance : General lack of repair or improper maintenance ; Broken or non- yp d ttir.. <br /> Vw .-► 9 ` ���, Y <br /> 2 functioning sink/toilet/bath ; Lack of hot water . Floors : Not clean , properly covered or in k m o i^ � 0 <br /> 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 . te <br /> ❑ <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 /> 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 /> ❑ 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 /> ❑ 6 Garbage Receptacles : Inadequate number of garbage receptacles ; Lack of or inadequate n �lo � 1K <br /> close fitting covers ; Garbage receptacles unclean or in disrepair. jf ZIJ <br /> Public Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other t%+51a( e v3L C t-'° <br /> 1 r <br /> 7 ' publicly shared spaces . 6 ceS i3s <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 , <br /> of or inadequate smoke detectors or fire extinguishers ; Inadequate lighting ; Inadequate Iy� <br /> protection from weather; Inadequate sewage or water facilities : Lc. � <br /> Pest control Used ? ,KYes ❑ No Company Name : jun^ C �( ., ,_ �/-� Frequency : )0 <br /> Hotel/Motel Business License? [ZYes ❑ No 1 3 0 Z <br /> Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br /> Rooms inspecte ' ,S`� �. 3 G l✓ � �` 3 `� L y7 Ji <br /> ' <br /> ` 0 �L 5; • U , <br /> Comments : w 7' 'L � L•�0 23 L L3 �, 4/ <br /> , Lyz � 9il <br /> ` q01 , ,10 L I t6 ,� Zo Lo <br /> All violations in rooms not inspected must also be corrected . <br /> All re -i , s -ei ns by the Env ' ronmental Health Department will be billed at the current hourly rate . <br /> Received By : Title : .� <br /> Environmental He pecialist : " J �` Phone : Zo9 lj �._ c� LU Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />