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Aq�Aty SAN JOAQUIN COUNTY <br /> .coG ENVIRONMENTAL HEALTH DEPARTMENT <br /> 44 <br /> ti <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 : — Inspect' lea eLt, ,� <br /> S ` //,, nn f � I ,`'�h <br /> Address : <br /> �L �+ PE , P ` V <br /> Owner/Operator: Pho t <br /> Annual Inspe ion El Complaint Inspection El Consultation Inspection ElRe- 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 /> ❑ 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- `� � mor 0 W1 t6f <br /> 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 �IL�/fi+ W3 <br /> damage , peeling or deteriorating paint ; Dampness or excessive moisture in room . t <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 /> ❑ <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 /> ❑ Public Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other <br /> 71 publicly shared spaces . <br /> ❑ 8 . Pest Control : Infestation of insects , vermin or rodents . <br /> k <br /> 9 . Other Nuisance : Any other condition which is hazardous to health , <br /> Other Substandard or Unsafe Conditions : Electrical , structural , or plumbing hazards ; Lack ' (no <br /> 10 . of or inadequate sRVLedetec s or fire extinguishers ; Inadequate lighting ; Inadequate ? � : 5 rarse d e.te.Wir <br /> protection from weather; Inadequate sewage or water facilities . <br /> Pest control Used ? LK Yes ❑ No Company Name : u e w equency : 2, 'f;" Y\ " <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 /> 11101111111111111 <br /> Rooms inspected : 1XZon <br /> .. IC 0101 04 <br /> Comments : <br /> m <br /> ho t <br /> le, ]Pig+ <br /> Ink 11nTon e tri l r n ` <br /> All violations in rooms not inspected must also be corrected . <br /> All re -inspections by the Environmental Health Department will be billed at the current hourly rate . <br /> Received By : � ��� Title : a ry <br /> Environmental Health Specialist : s Phon Page 1 of <br /> EHD 24-01 4-30- 12 HOTEUMOTEL OR <br />