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p4"'" SAN .10AQUIN 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 HOTEVMOTEL OFFICIAL INSPECTION REPORT Name of Facility: j Inspection Date: c �" / L l s l s Address: A)O\v' bA U ( l s="�r�t�l c��,. — — PE�y� PCR: Z 00 Owner/Operator: r� --- - — - -�-- C),6 Hin5 r yLt1 L�.-� Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re Inspection # Units in Facility: # Units Inspected.- I 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- 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). ❑ Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or 5. 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? -RYes ❑ No Company Name: Frequency,.— Hotel/Motel requency:Hotel/Motel Business License? ❑ Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcemenUFire ❑ County Code EnforcemenUFire❑ Other Rooms inspected: 1,C-3 t !c 1 2 (,-2- a;C, I , -4 a;-3 Comments: 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: �., C,17'z�) Environmental Health Specialist: Phone: Lf Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR