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�pQH!N c SAN JOAQUIN COUNTY 7 ENVIRONMENTAL HEALTH DEPARTMENT N[ I < 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: t3uo ocT jn44 9� ")T1\J' Of v-Awc c'7d1v Inspection Date: U� �� y Address: 34fi3 vJ i*}MoeQ 1.W. , AGK TO►J PE: u PR#: Owner/Operator: t10 Phone: ❑ Annual Inspection XComplaint Inspection ❑ Consultation Inspection Re-Inspection # Units in Facility: # Units Inspected: q 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 clegoliness&sanitation;Accumulation of debris,trash, garbage,combustible Items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2 functioning sink/toilet/bath; Lack f hot water. Floors: Not clean, properly covered or in good repair. Walls&Ceilings: all eilings in need of cleaning or repair: Holes, water damage, peeling or deteriorating paint; Dampness or exces Ive moisture in room. ❑ 3 Heating: Lack of approved heating in each unit; Approved heater not maintained in a safe, working condition; Lack of adequate heat(Standard: 707 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. ❑ 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: Frequency: 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: X06', I10 I2,4 129 Comments: 15 VZO 6UbS J>J PWOHS, f JOS- /JO /L} JZ /2.8. COnaa"'JIT AftnuC,o O/J Oy ;y 2.013 r1 W lu j / 2013 , GOi✓IP�ftivT J�J✓f'�Lyio,�tr C04VL)1 142 ON OJI 2 3/tO) /,WO 2 Y112-00 CtJNfi/1,fW(0 /W eA&> 5�1."- -)/= '6cb 'dpi-r. 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. Received By: Title: Environmental Health Specialist: Phone: �-jb�" 3 Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR