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Rq�,y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT p Stockton CA 95202-6232 1868 East Hazelton Avenue, �� Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: I l y 2 L 1 �CTevo S 'I Address: Q-BLAH W. Haab L rx 2\9 PE:2-4 PR#:ps.2. I LIV Owner/" a ato ia CIO-2,rVAQ Phone: 2og-yq,57 -4 Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: C1 2 1 #Units Inspected: ILA 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' 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). ❑ b Beddin : 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. ❑ 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. ❑ j 9. j 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?K Yes ❑ No Company Name: CLb Frequency: VA t)ft_Mt4 Hotel/Motel Business License? Yes ❑ No 1 2 1 Z ( I Z LX)! -1 -0 Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire El County Code Enforcement/Fire❑Other Rooms inspected: Comment o ) (SM t H64 a Ve At vr, AA _ AW_ t Gln - 0 �I All violations in rooms not inspected must also be corrected. AI re inspectio s by the Environmental Health Department will be billed at the current hourly rate. Received By:T� Al�� 'Amt�' Title: (5i MI A"-O KAWAk4� Environmental He h pecialist: Phone: 1q G` ` 0 Page 1 o � t to EHD 24-01 4-30-12 HOTEL/MOTEL OR