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a pq�1y SAN JOAQUIN COUNTY ENVIRL� IJMENTAL HEALTH DEPARTMEI` , a: a 1868 East Hazelton Avenue , Stockton , CA 95202-6232 p.' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: WW 4 Inspection Date: �• Address: /! �! 'K /�� L� �7 P PR#a3�reW6 Owner/Operator: GL �/lL / Phone: 46 _I�3 nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection # Units in Facility: # Units Inspected: 7 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. ❑ 3" Heating: Lack of approved heating in each unit; Approved healer 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. ❑ 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. ❑ 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? jtn2 ❑ No Company Name: Frequency: Hotel/Motel Businest License? C9 Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: e7y091 7Z2f� 37e Comments: / 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 --- '-- Title: Environmental Walth Specialist: Phone: / /�j Page 1 of EHD24-01 4-30-12 Y✓ " HOTEUMOTEL OIR