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o,q�ly SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT .z ` 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd �/FOR�`4 HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: p�C-y � e c�F r, AY ffI C4 :#QJ 1 '9 Inspection Date: Address: G /�T� ,i d� J � LA- `� 1 PE: PR#:0572 —1 Owner/Operator: r i /�i 1 C) E/' 1 I J /�G & Phone:.20 -41d- - �1'1 _-75 v/"SAInnluf Annual Inspection'F] Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection `C O' 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): ❑ 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/toilet/bath; Lack of hot water.Floors: Not clean,properly covered or in �' ( 'U�)0 good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repaird¢��rnrater 1 b m cowi G damage, peeling or deteriorating paint; Dampness or excessive moisture in room. s . F-1 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. ❑ s 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 17,& 160-p 0A 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <4(*1~� protection om weather; Inadequate sewage or water facilities. Iq Pest control Used? Aes M No Company Name: Frequency: Hotel/Motel Business License? Yes [] No a 10 eY) Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: 1 22 2 12_1.'2 22 21303 113 3_3 a f Comments: � CA y IV 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: 6 an rie I Environmental Healthp c t: Phone: /7 j\ 7 S` Page 1 of EHD 24-01 4-30-12 �'li HOTEUMOTEL OR