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„qvfly SAN JOAQUIN COUNTY �� ENV10,11 MENTAL HEALTH DEPARTMENm' •Z. `I 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.slgov org/ehd Leg"”' HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: a:20 Iblarrh PE: I PR#` -7p/.0 Owner/Operator: Phone: �� ) Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: # Units Inspected: Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): ❑ 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2. on- 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness or excessive moisture in room. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, F-1 3' working condition; Lack of adequate heat(Standard: 70°F at 3 feet from floor). Drinking Utensils&Ice Buckets: Not protected from contamination; Lack of or improper ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging (multi-use)or individual protective wrapping (single-use). ❑ 5' Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest. F-1 ' 6* Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers;Garbage receptacles unclean or in disrepair. ❑ 7' Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other publicly shared spaces. ❑ 8. Pest Control: Infestation of insects,vermin or rodents. ❑ 9. Other Nuisance:Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack ❑ 10, of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: Cc cc. Frequency: ,q,, Hotel/Motel Business License? Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: / ZZ 2 .zp 2-3 _7 Z 3 1 40 z Comments: All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. ec ',ed By- ` Title: Environ ental Health Specialist: Phone: s` !� Page 1 of / EHD 24-01 4-30-12 HOTEUMOTEL OR