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oaq"l 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: / N, �� S � Inspection Date:I/r �-�L Address: � X&q / f` PE: PR#: Owner/Operator: V Qty�S k Phone: Z q'Y��— `y3 Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: f 1 # Units Inspected: 2, 1 Reinspection On or About: The itemd 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. on- 2 functioning sink/toileUbath; 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, ❑ 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). E] - 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. ❑ 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?;V Yes ❑ No Company Name: Frequency: /Vh,k1,4 Hotel/Motel Business License? RYes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: Comments: .25,re ti ;/�� r Q Yt - ` S' /VO 1.&S ;,-e— CbK4 -7 AID ' 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: f2R--ril- Pi�H-f L Title: PAAnJA-ktl2 . Environmental Health Specialist: /I„ ` 'j Phone: 9 -6w Page 1 of EHD 24-01 4-30-12 �✓2d — HOTEUMOTEL OR