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ozi <br /> 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: Inspection Date: '2' <br /> Address: = s2l PE:A4. PR11657O ::tZLD <br /> Owner/Operator: Phone: <br /> 57 <br /> XAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: t p # Units Inspected: rV Reinspection On or About: Alk <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 /> F1 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 /> 2' <br /> functioning sink/toileVbath; Lack of hot water. Floors: Not clean, properly covered or in <br /> tP" good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water v V 'e^"'T R. VK � 7 <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> rF-1 <br /> 3' Heating : Lack of approved healing 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 /> e 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 /> ❑ e Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> ❑ Public Areas: Unsafe or unsanitary conditions in kitchen , hallways, stairways, exits, or other <br /> 7. <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 inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities, <br /> Pest control Used? Does ❑ No Company Name: Frequency: U <br /> Hotel/Motel Business License? ❑ Yes ❑ No Cyl Ove Itis <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcemeriffire ❑ Other <br /> Rooms inspected : a, Z ► 2C7S; A ,] 5 3 Z 3 <br /> Comments 0A 0j — <br /> II violations in rooms not inspected must also be corrected <br /> AII�Xemlnspectlons b t e nvi en aHealth Departmentwill i ea e current hourly rate. <br /> Received By: V' F Title: <br /> Environmental Health Specialist: Phone: / _ d 3 Page 1 of <br /> EHD 24-01 430-12 b :: D <br /> ISI 3 / 3 / 7 <br />