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Aq!!!>y SAN JOAQUIN COUNTY -'� ENVIRONMENTAL HEALTH DEPARTMENT X 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: Inspection Date: t3)o(�E•T IN,� 9- t!'Ui rEv` Of v�Tv�fc'ro� U6 /0 1.vly Address: 3; 3-3PE: PR#: �M M v Q L 1J- , V'IOGK.'TUwr Owner/Operator: �E hIOTIE, I1JG Phone: ❑ Annual Inspection XComplaint 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): ?tr Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, �I t' garbage, combustible items lar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2. on- 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—o—re-R—cUnive 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: 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. ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair. F-17. Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other: 7. publicly shared spaces. l 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. JUrS, Ij0 I L & I2-Y Comments: lS;/bS /N !00rrS f :0S- /l0 /2•} Q /22. C onpt'alAj0° aacwc-io ON c)&-),y Zo13 /I da lv i �- 2013. GDiv7P�Fh T /nJ✓PFG7iU,w CONDUCI'CO vN Orz,-37t—o)3 AWO IQ12 Y)2-00 CVVF1Wr0 PX Of 41b QUA 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: ,fib r Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR