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oAquly � <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 /> p HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> �/FORS <br /> Name of Facility: r Inspection Date:16 I <br /> Wofflul b 1 <br /> Address: /� �1 /� O `^I r q n \ PE 24n <br /> PR#: <br /> i� <br /> Owner/Operator. C7 `n �`� n r11`,n �� � 1 PhonN;0 qq <br /> --WA—nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: # Units Inspected: I Ch 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- <br /> 2. <br /> on-2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in <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. <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 /> ❑ 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 h�` �{1 �DII YQI►1 s <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> � y <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? XLYes ❑ No Company Name: L Frequency: <br /> Hotel/Motel Business License? AYes, ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 1 {211 22� 1 IM235, 2,n I <br /> GA*wenTs: <br /> C <br /> -2 <br /> no Meg rk <br /> In-e. m i Q n <br /> All violations in ro ms not inspected must also b6Jcorrected. <br /> All re-inspqctiorim-hy the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> �;M iv <br /> Environmental Heat pecialist: ' Phone: ge 1 of <br /> cl ul v <br /> EHD 24-01 4-30-12 HOTEUMOTEL OIR <br />