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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �: <1 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> ' Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT , <br /> Name of Facility: A90 Wo Inspection Date: <br /> Address: 8 <br /> 1 PE:Z q03 PR#: 4? <br /> Owner/Operaatolr: V r. <br /> ( — Phone-1 <br /> kL (2-A, <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: - #Units Inspected: )ti 1 Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- her V4%. 3 4N4pct,l <br /> functioning sink/toileVbath; Lack of hot water. Floors: Not clean,properly covered or in <br /> � <br /> 2. good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. is L,1OZ- <br /> 3. <br /> kF� <br /> Heatin : Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> working condition; Lack of adequate heat(Standard:70°F at 3 feet from floor). <br /> Drinkinq Utensils&Ice Buckets: Not protected from contamination; Lack of or improper <br /> 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> ❑ 5 Bedding: Mattress/linens infested with lice,bedbugs,or other insects; Not free from filth or <br /> foul matter;Unsafe; Linens not changed weekly or before new guest. <br /> ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> ❑ 7. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> publicly shared spaces. <br /> ❑ s. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack <br /> ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? Yes ❑ No Company Name: Wo�. requency: O <br /> Hotel/Motel Business License? YYes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: Zig 4 A�110 AIDAA ku <br /> Comments: `S-w - �e7l <br /> 1� 4 <br /> All violations in rooms not inspected must also be corrected. <br /> AjLw,-inspections)aXthe Environmental Health Department will be billed at the current hourly rate. <br /> Received B Title: „l' <br /> `nvironmental al pecialist: hone: Za kc ,9' Page 1 of <br /> EHD 24-01 4-30-12 ��f� ���( i�; _� HOTEUMOTEL OR <br /> i <br />