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p9L. .N\ SAN .IOAQUIN COUNTY /p.••• ....•..0 la :i ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton. CA 95202-6232 Telephone: (209) 468-3420 -ax: (209) 464-0138 Web: _rvw.slgov.orq/ehc HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: s. PE:a I 1 PR#OZcj00t / � �7 b_ Owner/Operator P Phone: Annual Inspection Lj Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: Z ig ' # Units Inspected: Reinspection On or About: AiA 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): p Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, `f garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2. on- functioning sink/toileUbath; Lack of hot water. Floors; Not clean, properly covered or in �"� •� "ted�- 2 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: 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). ❑ 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. ❑ 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, 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? Xes ❑ No Company Name: Frequency: Hotel/Motel Business License? ❑Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected JJZhni� CA A Comments: All violations in rooms not inspected must also be corrected. All re-inspections me billed rent hourly rate. Received By: Title: Environmental Health pecialist: Phone: , 1 ! f�_�3-3 Page 1 of EHD 24-01 4-30-12 �l b HOTELWOTEL 0IR