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AQ�I� SAN JOAQUIN COUNTY <br /> Er.IONMENTAL HEALTH DEPART 'NT <br /> Nl ` 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> HOTEUMOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: rF1" 1-1c�TL�Z Inspection Date: o o� /L/ <br /> Address: /;O s _l� JV,L_j OhJ ✓V/PJ� J'IMGK r0AJ PE:2yl_} PR#: /°12()2 y&YJI'— <br /> Owner/Operator: Jif f � Phone: <br /> Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: # Units Inspected: 7�- 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- 1'1'/ <br /> 2 functioning sink/toilet/bath; Lack of hot ter. Floors: Not clean, properly covered or in <br /> good repair. Walls&Ceilings:Wall ,ceilin in need of cleaning or repair: Holes, water <br /> damage,peeling or deteriorating paint; ampness or excessive moisture in room. <br /> ❑ 3 Heating: 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 /> Drinking 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 j <br /> foul matter, Unsafe; Linens not changed weekly or before new guest. <br /> ❑ fi 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 /> ❑ 8. 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 /> El 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? 71 Yes ❑ No Company Name:/h t-/bo i, f Frequency: dNl,- Not! <br /> Hotel/Motel Business License? ❑ Yes ❑ No <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 139 /3-�- 0 13 y //,? /l6 <br /> Comments: If! -. ptltUNG /R7NT /W Mvfi ooh k47m fA9:i-1 iN u vi vc /loon onu�v&(not L,69rjub Hzcob 7-D crcv11t'1r) <br /> _#13y- /101,0 iZ OfttoAj s7MW W 47741,oPn 6e�7 OAJ& 9&tA1,6 &161 7 fiX 444'COLOZ 1,A4 617MADPI <br /> N&"t41' L«1tT -6) Avvn X33— /Wim- COWL, <br /> �l CrJ£ZfC 1�!C G� <br /> 9,0iP& ?'t <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections,bV the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: Title: <br /> Environmental He pecialist: Phone: <br /> Page l of / <br /> EHD 24-01 4-30-12 HOTEL/MOTEL OIR <br />