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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 �►� 1868 East Hazelton Avenue, Stockton, CA 95202-6232 . a Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sagov.or /q ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: Ex e,< Vv_Q Inspection Date: Address: S PE:Zy Ib PR#: zZ Owner/Operator: Phone: J,S 'Annual Inspection ❑ Co plaint 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): E Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, IVA garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- ti•+ are, 2' functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in �—VK il5 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. ❑ 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 wea er; 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: _Z_ ' Ia, Comments: , All violations in rooms not inspected must also be correcte . All re-inspectionm5e Environmental Healthe a men will e t e a 0-Current hourly rate. Received By: s Title: Environmental H alth Specialist: Phone: Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR