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OPQ FOR�;p SAN JOAQUIN COUNTY ENN ONMENTAL rIEALTH DEPARTN IT 1868 East Hazelton Avenue, Stockton, CA 952076232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: - Z`7 / 7 d1: PF_ -Z PR#: Owner/Operator: y Phone: Annual Inspection ❑ omplaint Inspection ❑ Consultation Inspection p ❑ Re -Inspection # Units in Facility: / t�S # 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): ❑ 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 functioning sink/toileUbath; 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. ❑ 37 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). El5' 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. E] 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. ❑ 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? ❑ Yes ❑ No Company Name --7P—/,4 Frequency: ,.. Z Hotel/Motel Business License? [KYes ❑ No Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected:1_77 / Z/ % /c' / 5 - / - / / - �- Comments: // �./ lvf w lr�u 6c S�r-t/ lt�. eyk All violations in rooms not inspected must also be corrected. All re -ins ections by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmental Health Specialist:15 " ' Phone: &,= .- 3 TPage 1 of r �� EHD 24-01 4-30-12 HO rtL / MU I tL OIR