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J q UON SAN JOAQUIN COUNTY ' t =Vto, `%11� ENVIRONMENTAL HEALTH DEPARTMENT : . � 1868 East Hazelton Avenue , Stockton , CA 95202 - 6232 PY Telephone: ( 209 ) 468 - 3420 Fax: (209 ) 464 - 0138 Web: www . sjgov . orq/ehd NZA� 1FOR HOTEL/ MOTEL OFFICIAL INSPECTION REPORT Name of Facility: a C ' f �C n c c n Inspection Date : t/ �/ 9 Address : /S` v �•�v' (N u PE : ZVIC PR#: OL 0035 Owner/Operator: e ( V ' (coonPhone : Zo 76T -0W — Annual Aspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection # Units in Facility : 2 C� # 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 ) : ❑ Room 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 ,- functioning on - functioning sink/toilet/bath ; Lack of hot water. Floors : Not clean , properly covered or in 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 . ❑ Heating : Lack of approved heating in each unit; Approved heater not maintained in a safe , 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 improper ❑ 4 . washing & sanitizing after each use (multi - use) ; Lack of or improper protective bagging (multi-use) or individual protective wrapping (single-use) . ❑ 5 . Beddin : 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 . ❑ 6 ' Garbage Receptacles : Inadequate number of garbage receptacles ; Lack of or inadequate close fitting covers ; Garbage receptacles unclean or in disrepair. ❑ Public Areas : Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other 7 , 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 ❑ 1o . 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 : (LU J OY114 o%, PSj- Frequency : Hotel/Motel Business License? Yes E] No 36 Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other NINE 1111111111111110 Rooms inspected : Comments : v e ( C 'h ^ tittooto % ) oone ,2yLotlS CY � violl� fi�o f obScYV �� All violations in roo s no ' spected must also be corrected . All re - inspections by the Envir nmental Healjb Department will be billed at the current hourly rate . Received By : e : Low Environmental Health Specialist: J M1 r,/ Phone : l./ 6 � 3 f! Page 1 of 1 HOTEUMOTEL OR EHD 24 -01 4-30- 12