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ap.,q*ly. 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 HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: G Inspection Date: < r✓+�iC Address: Z-7 10 �+ / PE: PR#:d Zt{p/ll Owner/Operator: ev-c //,(� Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: f, #Units Inspected: 'L I 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- 2. on- 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). 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. ❑ 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 1(./�5-( /In 2q3,,Z37 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate •5c f3/ 3 '7 7, protection rom weather; Inadequate sewage or water facilities. Pest control Used? NFIYes ❑ No Company Name: Frequency: 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: / J.V57/y Zst.2y3 Z�{ Z37 Z Z7 ?_CSS La 3 0 31 z Comments: IV,( r /kynIj ,4e- Ptef i�s Lie. All violations in rooms not inspected must also be corrected. All re-inspections b the Environmental Health Department will be billed at the current hourly rate. Received By: Title: �, Environmental Hea S cialist: ,:,' 6,,, Phone: Z� v/ Page 1 of EHD 24-01 4-30-12 �! HOTEUMOTEL OIR