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AqU,�,. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 C,' '- t ,'W W. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.swgov.org/ehd .....Q HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: —Za�3 Address: ✓� Mare,�- s7UC.� PE:Z q`) PR#:U' 72.f3C Owner/Operator: Phone:Zvc I 172 -9;b-c) Z - , ;bU ZIAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: 18 q #Units Inspected: i3 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- ❑ Z 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). ❑ 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. F-16. Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 6' 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 -L/L(j7 V, Z351 3Z, 3Z_j7 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather- Inca e—quate sewage or water facilities, Pest control Used? ®Yes ❑ No Company Name: "LtsL Frequency: } Hotel/Motel Business License? E Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: 7-/ L 301 Z 3 y 7-35" C�t�. 3""12> 3-3 I �L Comments: 34 _ -�1,, Z 3 s Z 3 C, S,,c ka Q ,f 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: Caw�+-�( ,� , I �' � Environmental Hea a ist: Phone: �LSrF�/yt �7 2oC —6,10 r>'nlI5 Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR