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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 'l Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.slgov.orq/ehd .......... F ..... HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: tW ' �' Inspection Date: Address: i 5 V i 0 uI `p_ d I 1 �+ 1 9 1 I) W 1 � PE d J (0 PrEV/1 Owner/Operator: 06 i ' �hAll 166+ Pho 42-21 q nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: #Units Inspected: 3, 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): El garbage, Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, 1' garbage,combustible items or similar materials. Room Maintenance:General lack of repair or improper maintenance; Broken or non- 2. on- 2 functioning sink/toilet/bath; 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 4afe,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 improp❑ 4. washing&sanitizing after each use(multi-use); Lack of or improper protective baggin (multi-use)or individual protective wrapping(single-use). ❑ b 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. ❑ s 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? Yes ❑ No Company Name: requency: t;' 111 Hotel/Motel Business License? KYes ❑ No 12-131 UZ,O Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: Comments: %0 r r r 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: 0cc;� y\ Environmental He Ith Specialist: Phone: — Page 1 of tv HOTEUMOTEL OR EHD 24-01 4-30-12