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p�a�ln. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT �; i ►. 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspectio Date: at e:; 5W Su 2-124 l! Address: PE: PR#: Gov sv641 570 X D Owner/Operator: Phone: svL Y -A 42 2 cwt ❑Ann al Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re-Inspection #Units in Facility: /Lp #Units Inspected: p 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. ❑ s 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 ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? RYes ❑ No Company Name: ejcj4Q Frequency: yG� Hotel/Motel Business License? [AYes [] No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected:-if:� -4 3 Z 3 # 3 L11--V9 Comments: tj.0tN N All violations in rooms not inspected must also be corrected. All re-inspections by the vironmental Health Department will be billed at the current hourly rate. Received By: --� Title: Environmental He-a-ffh Specialist Phon Page 1 of EHD 24-01 4-30-12 HOTELIMOTEL OR