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/Aq 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 HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility:S� Inspection Date: Address: PE: I PR#i D O S dc h� Owner/Operator: Phone: q6(, jjAOt. Annual Inspection ❑ Complaint Inspection [I Consultation Inspection [:] Re -Inspection # Units in Facility: 3 # Units Inspected: 3 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. Roo_m(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- C4:04 Ej 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. ❑ 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. ❑ 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. [ B. _ Pest Control: Infestation of insects, vermin or rodents. S -&K Z 1 ❑ 9. Other Nuisance: Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack iL K.'Z_ 3LJ w�c ssc 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: Frequency: Hotel/Motel Business License? ❑ Yes ❑ No Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcemenUFire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: Lj1 v� Comments: Ca, qlo o4,e— c&nAA<4AntC 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: Title: Environmental Healt pecialist: Phone: Page 1 of h EHD 24-01 4-30-12 HOTEUMOTEL OR