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OYOti_r.. SAN JOAQUIN COUNTY —rr,-• a ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd hl Rte` HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: T-5 ` n1 Inspection Date: .JJ 1I�r g -7 ZQI$ Address: 2�O c NOV PE:2 •�0 rrPR�#C�: �O L 1�(1Z�G` O Owner/Operator: Pd-KL )C,,"AMP Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection =J #Units in Facility: #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, garbage,combustible items or similar materials. Room Maintenance: Ge r r or improper maintenance; Broken or non- tis+ 120 1 P(0) i0,$ f ctionl sink/toile at Lack of hot w ter. Floors: Not clean,pro�Covr 2. i� 9 p17ai '1t om 'FimrQ b MIgo air.Walls&Ceilin s:Wall 'lin s n need of cleaning o C)r' wyouln (2,tU,nds tr) damag eelin or eteriorating paint ampness or excessive moisture in room. !htt cl'i ih,4V 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). Drinkinq 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. 101 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate �1'1Gn D 6. Ta c e- close fitting covers;Garbage receptacles unclean or In Isrepair. Cl� Le'� P7. ublic Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other VV0 le". 1XI V�r_C�A& �1 publicly shared spaces. °0� � 8. Pest Control: Infestation of insects,vermin or rodents. " O -iz- 9. Other Nuisance:Any other condition which is hazardous to health. � y1)I�U2J��n Other Substandard or Unsafe ConditionsAlectro kstructural,or m Ing h and Lac 1�0 LO(O �� w 2,1'b,2, 10. of or' equate smok�detecto ire e i er ; Inadequate Ig in na equaZ,3�rotec Ion rom wea aate sage or water facilities. uvl G:"-4?DL Iv$-N Pest control Use e o Company Name: Frequency: Hotel/Motel Business License? Yes E] No ILIO W,f fs K ty L sdictional Violations to beReferred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other spected: 1201� g �� (a 23 2,?is:Qm 21 --f1� cidm oil' QQ r KrO e ' uI: h 1 0 DUE- rna Q(0 _ r-0 a U� tD e, In S Mt� ha� h0 � s s u U All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Receiv By: 'll g it :ma(W 13 Xe i-r Environmental Health Specialis: 1 � Phone: a (Z _2Page 1 of EHD 24-01 4-30-12 ,:: FOfV"UAd EL O1�