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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 �'•' '� Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd 4�!FURa`p HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date. 7 /j?//_S7- Address: 173 PE riVl -Soi Very ,f�� PRVZ_ .p� Owner/Operator: Phone: �1 4 IP44 I Y�-� ti 7� Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: Gn 1 #Units Inspected: Reinspection On or About: The items checked below are violations to be corrected. I 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- ❑ Z' 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. ❑ 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). ❑ Bedding: Mattress/linens infested with lice,bedbugs, or other insects;Not free from filth or 5' 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 F-1 �' 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? 9 Yes ❑ No Company Name: 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: ,3 Comments: ,A /V A ;_11 11(.-A 4.1--1 64a le-1 All violations in rooms not inspected must also be corrected. All re-inspectionsllipy re-inspectionsthe Environmental Health Department will be billed at the current hourly rate. Received By: r Title: Environments Health Specialist ,��_f Phone: S-2 Page 1 of EHD 24-01 4-30-12 �"'"' HOTEL/MOTEL OR