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SAN .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT N 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: lN te G u c � Inspection Date: 6_1`1 Z Z Address: 7 z3 v5 S. c)( �lJC �U �i PE: Z r PR#:�� Owner/Operator: v�_17 ,r�,L� Lam, Phone: v� 1 Z7/-2W nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ElRe-inspection #Units in Facility: j # Units Inspected: 1 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- F] 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 Al l damage, peeling or deteriorating paint; Dampness or excessive moisture in room. �J ❑ 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). V F-1 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. ❑ Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 6. 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 fr m weather; Inadequate sewage or water facilities. Pest control Used? JX Yes ❑ No Company Name: Frequency: `Tj07 -k. Hotel/Motel Business License? N Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: Comments: V ;71fv Y eSC- C ✓o iI-V 'I . 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. Received By: Title: Environmental Health Speciali CM Phone: 0 9) 5_ 7-cu/ Page 1 of EHD 24-01 4-30-12 HOTELIMOTEL OR