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ao0.R � o SAN JOAQUIN COUNTY r`s ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd P HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: c.' l�0 Inspection Date:/ (Z- i J ? Address:.5-1qu N S< PE: PR#V�c Q 37 Owner/Operator:c 1� ` N Aku Phon(Z� " t "Annual I spection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection # Units in Facility: 30 # Units Inspected: 5 I 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 cleanliness & sanitation; Accumulation of debris, trash, garbage, combustible items or similar materials. F -1 2 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 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). ❑ 4. Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper 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. ❑ s 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. ❑ 10. Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack 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: Lj I<ZJ Frequency: A4,tjt Hotel/Motel Business License? J0 Yes ❑ No Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code. Enforcement/Fire ❑ Other Rooms inspected: �3 2 7S Z� Comments: l) All violations in rooms not inspected must also be corrected. AIV-inspectiopjs/by the Environmental Health Department will be billed at the current hourly rate. ~ Title: Received By: (__� — Gw Environmental Health S ecialist:Phone: Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR