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SAN JOAQUIN COUNTY <br /> (Q ENVIRONMENTAL HEALTH DEPARTMENT <br /> tiNMal 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> \'. p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www siclov org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> Address: - ------ —..._ <br /> �'1. �. � �— �CZ (n."�co�• 1l'�CGtc� PE:zq' PR#:�z� — <br /> Owner/Operator: Phone: <br /> 2c`( "f 75 -d�I3o <br /> Annual Inspection ❑Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: I I i # 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 /> ry <br /> 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, ct i-. 1%161C_ sg <br /> garbage,combustible items or similar materials. J1^. t''Z WtZC-Gid 15V;AA& . <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- {2 V, Z - n^-C'(c 1 <br /> 2 functioning sink/toileUbath; Lack of hot water. Floors: Not clean, properly covered or in 1� S c I V--ej- `1 <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, lot <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 /> ❑ 5 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 /> ❑ 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 f4-Wk l 1 <br /> 10. Iof or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from we er; Inadequate sewage or water facilities. <br /> Pest control Used? Y Yes [-] No Company Name: <n Frequency: <br /> Hotel/Motel Business License? ❑Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code EnforcemenUFire ❑ Other <br /> Rooms inspected: kC( I Z <br /> Comments: t <br /> r, vw <br /> II violations in rooms not inspected must also be corrected.-*N.,, <br /> All re-inspections by the Environmen a ea WM Me bill Tat—the current hourly rate. <br /> Received By: / ( / Title: <br /> Environmental Health Specialist: r �\ Phone: L� Pae 1 of <br /> EHD 24-01 4-30-12 HOTEL/MOTF! OR <br />