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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: /7u _/ @ a / o / Inspection Date: Address: 0 Owner/Operator: Phone: �ra{�i� l2at Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: U # 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. IZOOm(S� : F1 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- F-1 2 functioning sink/toiletlbath; 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. ❑ 3' Heating : Lack of approved heating in each unit; Approved heater not maintained in a safe, working condition; Lack of adequate heat (Standard: 701F 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. r❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair. F] Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other 71 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: k3 Fi Frequency: �Ljp Hotel/Motel Business License? ❑ Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcementlFire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: / / '7 f / Z Comments: de 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: y 4 Title: Environmental Health Specialist: Phone: f/j page 1 of EHD 24-01 4-30-12 U HOTEUMOTEL OIR