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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:vvwvv.sigov.or_q/ehc1 HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Faci sty: r Inspection Date: Olt 12-1 _)J' ress. ot PE.� PR#- IZ-:7 to Lf,0ZLfB Owner/Operato ho rL. 71�� Fgr Annual Inspection [:] Complaint Inspection Ej Consultation Inspection ❑ Fz-e-Inspection #Units in Facility: fT#Units Inspected: Q Reinspection On or About: AJI-14- The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Roorn(s): 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. 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. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, F� 3. 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 1 (multi-use)or individual protective wrapping(single-use). F, 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. I F-1 6Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate . 1 1 close fitting covers;Garbage receptacles unclean or in disrepair, ❑ `®r`otheiT___ Public Areas: Unsafe or unsanitary conditions in kitchen,hallways,stairways, exits,o—T ' publicly shared spaces. El 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-7 ❑ 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 7] No company Name: IX f evFrequency: ^yj�./ Hotel/Motel Business License? Wes E] No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected: I .'T'.IT 41-- Comments: 410 VA44tV;7Wa`hA "t All violations in rooms not inspected must also be corrected. All re= §pec1*n"y the Environmental Health Department will be billed at the current hours j rate. Received By Title: Environmentlth Specialist: Phone: T-27ill 2 Page I of EHO 24-01 4-30-12 HOTEUMOTEL OR