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Qoq�l>r. 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 P OR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: f Q p Inspection Date: Address: 2r1Ga , . 1 MG�G� I AVL• ��•�•pr✓�"!�'Ut/L- PE�LIO� PR#d507D0 Owner/Operator: f a*-yX_L 5S Phone: Xq-y-7 a-g Baa nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility; q.A I #Units inspected: I E> 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): ❑ 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- a2 y_ e*tinroow. ochr 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in �l 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. (6o yyt`'4Cp ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe,3' working condition; Lack of adequate heat(Standard: 70OF 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. ❑ 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 IC � l i►� 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? es ❑ No Company Name: E r,,o I Q,, Frequency: C Hotel/Motel Business License? XYes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected: 10k 'j0-) 1j10-;030 o?QoZ Comments: � 01 01) OV LiV�Q / �Z2e2GQ-, Cj!1 6� 1 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 B . Title: 0 Gna� " S r)otgon Environmental Health Specia' t: o 1 hone:U14 .2 1 page 1 of EHD 24-01 4-30-12 1 HOTEUMOTEL OR