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Pa''l ,- SAN JOAQUIN COUNTY 1,6 2;' ENVIRONMENTAL HEALTH DEPARTMENT —rr. ;G a 'a 1868 East Hazelton Avenue, Stockton, CA 95202-6232 >t Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: 1 ` Inspection Date:/ Address: t� D 1 - P'awg PR�7#- Owner/Operator: 'D15W Cl / /C .vv-1 a*'%j 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): ❑ 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- 16 , V BNS-}- 1 v-,- 10'q.AAkv 2 functioning sink/toilelbath; Lack of hot water. Floors: Not clean,properly covered or in \0 Y10"41 Aecnr�e�- good repair,Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water 134_crwq(! 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. ❑ 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 IO -5~;4L de-k C-}py- 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate WorVL'ih9 protection from weather: Inadequate sewage or water facilities, t 31�v rv..o - we;gxAe o Pest control-Used? Wes ❑ No Company Name. ,M Frequency: M 0 y1 Hotel/Motel Business License?lKyes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: 10,77 (�G j cl 230 )P Comments: 5m all ywevx ►roo vv% r All violations in roo s not inspected must also be correcte . All re-inspections by the Environmental Health De artment will be billed at the current hourly rate. Received By: f 0A Nik Title: Environmental Health p cialist: M I. i Phone: 1 ry _�6 Cl_R .a page 1 of EHD 24-01 4-30-12 Cx b HOTEUMOTEL OR