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SAN JOAQUIN COUNTY )�'Pi� •co 11 ` EN,., 30NMENTAL HEALTH DEPARTI4reNT 1868 East Hazelton Avenue , Stockton , CA 95202 - 6232 Telephone: (209 ) 468-3420 Fax: (209) 464- 0138 Web: www , sigov . org/ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: � /�_ 1 /� Inspection Date : Z7 Address : /' 7 � - �� 5 �'� Gia PE : ZW 6 PR#&2'vao Owner/Operator: T7 Phone : nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re - Inspection # Units in Facility: �A # 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. Room (s ) : ❑ 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 - tAi*'&W ❑ 20 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 . ❑ 3V 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) . ❑ 5d 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. ❑ 6V 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. aaaaaa Pest control Used? Yes ❑ No Company Name : eco Frequency: r Hotel/Motel Business License? ,JKYes ❑ No Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : Comments : ,; 8 -410 ree.oVL e q:aP7 All violations in rooms not inspected must also be corrected . MENNEN All re- inspections by the Environmental Health Department will be billed at the current hourly rate . Received By: 6 Title: Environmental Health pecialist : Phone : ^ _ j�� Page 1 of f EHD 24-01 4-30-12 HOTEL / MOTEL OR