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Qaq�ly SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd . t HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: / f� 7 © / Address: �• � (�. PE;, LLQ., P, Owner/Operator: 4C k K Phone: _ Annual Inspection ❑ Complaint 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): ❑ 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- ❑ 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. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, [_j a' 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 ❑ 6. 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? W,Yes ❑ No Company Name: Frequency: Hotel/Motel Busines icense? NYes ❑ No Multi-Jurisdictional Violations to be Referred to:E]City Building/Code EnforcemenUFire❑County Code Enforcement/Fire❑Other Rooms inspected: c !; ,& /p `� 0-57 jp7— O Zp Comments: 12&, lnbl All violations in rooms not inspected must also be corrected. 44 re-ins ections by the Environmental Health Department will be billed at the current hourly rate. Received By Title: Environmental th Sp iAIist: Phone: Page 1 of r EHD 24-01 4-30-12 HOTEUMOTEL OR