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Qgvi.^!. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 �. . • Telephone; (209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: 1, 1_e- Inspection Date: l.(.� CJ K.i 1. J y�/� Address: �Yt �') "�` Stoc-/ltC�� PE: 2yl PR#:O Z lj USO Owner/Operator: L`l G `� 1. Phone: 1,-, 325 _ 3 u ('Annual`Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: _ T_# Units Inspected: S 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:Wails/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, , y v ❑ 3. V working condition; Lack of adequate heat(Standard:701F at 3 feet from floor). V tsy s 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. F1 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. ❑ 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? 'g Yes ❑ No Company Name: (f S Frequency: n 0,tt Hotel/Motel Business License? 'XYes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: I C9 I I I 1, Comments: 'A't-ft' ( : & VltlydtLTOZI u It Si)u K e e c 4o/3 4"-T firoM 1 f 3e- • I tf rec D lire-inv v e m.e-,.r 0 i` A nom. C' All violations in rooms not inspected must also be corrected. All re-inspec ions by the Environmental Health Department will be billed at the current hourly rate. Received By: �,� Title: V Environmen ecialist: ^"1 hone: 2(; S�0(� Pa `- ` e 1 of �1 9 EHD 24-01 4-30-12 HOTEUMOTEL OR