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SAN JOAQUIN COUNTY —�- -2 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton; CA 95202-6232 .�r Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www sic HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: ��,vo -Ydi as Inspection Date: 3 3 Address: /O �� /o �'f; PE� _ PRL' O!f O Owner/Operator: 1 /i row r/�� e G S Phone: Annnnuu II Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility; 100 # Units Inspected: 10 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)- 0 oom(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- ceoer 1 eeel ❑ 2' 1 functioning sink/toilet/bath; Lack of hot water. Floors. Not clean, properly covered or in TiD'Sor.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). 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. ❑ 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. /13 ❑ 9. Other Nuisance:Any other condition which is hazardous to health, Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack ❑ j 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? NrYes ❑ No Company Name: „ Frequency: Hotel/Motel Business License? Yes ❑ No R239/1__ A1a-1w e,.,e'4_ Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: f/3 //L/ .3 12- Comments: 2Comments: 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 Environmental Health Specialist: Phone: _ S,— Page 1 of EHD 24-01 4-30-12 HOTEL M ITEL OR