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U'fy SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 ' ", Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:wv✓w.sjgov.orq/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility. Inspection Date: . //-02— Address: - Address: 91 1 2 V- n Q i`► I� E.� )t PR# f 1 n��CQ Owner/Operator: 'RA�c�-H RATe-L Phone:•, `i (J��V w nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: N1 I #Units Inspected: 5 1 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): ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, 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. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, F-1 3' 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. ❑ s. 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 ex ing ers; Inadequate lighting; nal d quate O protection from wea ; Inadequate sewage or water facilities. If � Pest control Used? Yes ❑ No Company Name: quency: Hotel/Motel Business License? 19Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: Comments: PAW QKWA All violations in rooms not inspected must also be corrected. A, re-injections by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: 0�/n ,(� Environmental palth Specialist: Phone: ' Page 1 of i EHD 24-01 4-30-12 I HOTEL/MOTEL OR