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Pq� N SAN JOAQUIN COUNTY �a ENVIRI . AMENTAL HEALTH DEPARTMEf . 1868 East Hazelton Avenue, Stockton , CA 95202-6232 ('= Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. org/ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: / /- / J� In Inspection Date: J `. Address: ,/ �( ut �W �q � L _ P PRik �4W6 Owner/Operator: K �` / "� Phone: nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: # Units inspected: 7 pection 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- F-] 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). ❑ 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. ❑ s. Pest Control: Infestation of insects, vermin or rodents. ❑ g. 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? s ❑ No Company Name: h Frequency: Hotel/Motel Businesi License? XYes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : W0 Z2 : RZL 32L Comments: a« s 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 R14 Title: Environmental lultalth Specialist: Phone: Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OIR