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SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-0333 Web: http://www.socehd.com/index.html <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL INSPECTION REPORT Date:0G/o/Zo/I <br /> Facility Address: 3473 W Hammer Lane, Stockton Program: zvc-v <br /> SUMMARY OF VIOLATIONS <br /> Room # 127 — Room currently occupied and has been occupied for 2 weeks, according to owner/ <br /> operator. Room not inspected. <br /> Room # 128 — Room currently out of service and being used for storage of dirty/soiled box springs. <br /> 2 dead bed bugs found next to the refrigerator; no live bed bugs observed on the furniture. <br /> There are mattresses and a couple of box springs in the back of the facility. The mattresses and box <br /> springs are ready for disposal, according to owner/operator. <br /> At this time, the EHD has not received any documentation re: disposal, new/replacement mattresses, <br /> and pest control company receipts for bed bug treatment(s) from the facility owner/operator. <br /> CORRECTIVE ACTION: <br /> 1. Clean/sanitize or replace all dirty/soiled box springs and/or mattresses. <br /> 2. Call Pest control company for treatment of roaches in room 108 and all adjacent rooms in all <br /> floors (see sample rooms below). Provide documentation to the EHD. <br /> 3. Vacuum carpet floor covering in rooms, including all corners and behind furniture and appliances <br /> 4. Clean and/or repaint walls <br /> Sample rooms ----> 109 107 105 209F2Z0V <br /> 205 309 307 305 <br /> 110 108 106 210206 310 308 306 <br /> FIRST FLOOR SECOND FLOOR THIRD FLOOR <br /> Failure to take these actions will result in the case being referred to the City of Stockton Hotel/Motel <br /> Permitting for further enforcement action. <br /> ALL EHD STAFF TIME ASSOCIATED WITH THIS CASE IS BILLED AT THE CURRENT HOURLY RATE($125.00). <br /> THIS FACILIT SSU ECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: Title: <br /> /Z4Glr1C�I111-e3 <br /> CONTINUATION FORM <br />