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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />s`a�1 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br />t' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.or /q ehd <br />`;Y HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br />Name of Facility: a*v% o4e, <br />Inspection Date: .20I / I �- <br />Address: I 5 (V 5 '!5. E I DO� G+ • <br />P4 L <br />PR#.icy OC) <br />Owner/Operator: 'IDOL V"k6t-AVI4'iDPM , ?ct�-e I <br />Phone: anq _ L16 G —5q�6 ) <br />nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection <br /># Units in Facility: <br /># Units Inspected: <br />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. <br />Room(s): <br />❑ <br />1 <br />Room Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, <br />garbage, combustible items or similar materials. <br />2. <br />Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br />functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in <br />good repair. Walls & Ceilings: Walls/ceilings in need of cleaning or repair: Holes, water <br />damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br />I " <br />cW �.X'� <br />M t>.5vssew— <br />1�Orn Q. <br />❑ <br />3. <br />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). <br />❑ <br />4. <br />Drinking Utensils & Ice Buckets: Not protected from contamination; Lack of or improper <br />washing & sanitizing after each use (multi -use); Lack of or improper protective bagging <br />(multi -use) or individual protective wrapping (single -use). <br />❑ <br />5 <br />Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or <br />foul matter; Unsafe; Linens not changed weekly or before new guest. <br />❑ <br />6. <br />Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair, <br />❑ <br />7. <br />Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other <br />publicly shared spaces. <br />❑ <br />8. <br />Pest Control: Infestation of insects, vermin or rodents. <br />❑ <br />9. <br />Other Nuisance: Any other condition which is hazardous to health. <br />❑ <br />10. <br />Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack <br />of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br />protection from weather; Inadequate sewage or water facilities. <br />Pest control Used? es F-1NoCompany Name: Q, Frequency: <br />Hotel/Motel Business License? Wes ❑ No <br />Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other <br />Rooms inspected: - <br />Comments: <br />V\ 1(1D 0 nnS <br />1 Ltd ) t <br />All violations in rooms not inspected must also be corrected. <br />All re -inspections by the Environmental Health Department will be billed at the current hourly rate. <br />Received By: \D y L I R ,'t Title: Q y\Q <br />r <br />Environmental Health Specialist: <br />(6 '1 <br />a� ,� �- Phone: 9-0ya „U �� <br />Page 1 of <br />EHD 24-01 4-30-12 V HOTEUMOTEL OR <br />