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PQ��y SAN JOAQUIN COUNTY EN 30NMENTAL HEALTH DEPART( NT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd A�rt'ORN HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: 0t7SM pS riv TCL Inspection Date: !?l 3/ 101V Address: 3y 3 ,ptrlN ti./L)/ojll/J J'T/l eET J`/17G fh I vti PE: .�,�i PR#w 2wrS'd- Owner/Operator. J IL61H 11 r�'L Phone: CRAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: Z # 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): ❑ 1 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- F-] 2 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. F] 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). ❑ Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or 5' 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 weather; Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: 6,qJ-T-L E ffi j r/1 1gCgAVency: ?x p 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: /D/ /OS l L 7,v() Z/ Comments: PrcrtN — s- �rnaoM- N 7�Z7i_/ )AJ 1 E 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: X Title: Environmental Health Specialist: Phone: tl/6�_ 9 � Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR