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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Stockton, CA202231868 East Hazelton Avenue, 464-0138 Web95wvrw saov2ora/ehd �:: '• Telephone:(209) 468-3420 Fax:(209) HOTELIMOTEL OFFICIAL INSPECTION REPORT C/FORS` Inspection Date'. Name of Facility: / �o PE: PR#, S �/7 d L9 O �t Address: �an 0� H,r7 Phone: Owner/Operator: M ZV_ Lo 4,_ Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: Q #Units Inspected: Reinspection On or About: The items checked below are violations to be corrected. Room(s): See Reverse Side of this Form for Detailed Summa of Violations and Code References. r Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, 1' garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 2. good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness or excessive 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. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate F-1 s. 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: ZZ f e I5��1 ?p t4? g ZS Z3 Comments: �� jr 2a/S �i Z.-01-41eleo� awe Pr�w - 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: j/ ^ Title: Environmental Health Specialist: hone: 1 Ll Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR