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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 � El- HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date:,S-/ 51,-7 I Address: 2ajp 5' 6t vomk 570 �/� PE: PR#:U5©�62.1 7If Owner/Operator: Phone: 31 ❑Annual Inspecti n ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection 7 1. #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, 1 garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2' ❑ 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). ❑ 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. ❑ 6 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. 521 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? 5&Yes ❑ No Company Name: Frequency: Hotel/Motel Business License? ❑Yes EK No VJ'AS qA , Multi-Jurisdictional Violations to be Referred to:M City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: , ILi Comments: v i ` J All vi lations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: ,� Title: Environmental Health Specialist: Phone: �;� 2 f� f 1 Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR