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ooq�!n SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s4.ov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: A /IO Inspection Date: 1 Address: P PR#: 1 9 5� Gaya-& oa Owner/Operator: � / \� $d Phone:Qpq _(�5 _ a Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: q #Units inspected: I I 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- ba46novv\. 0 0-�— 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in bAS 0'Wd i vi good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water I')e 4- nttaLs 'nP-Pwt`r 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 as _Svyw!-v e- -C fir—i e1 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate gym cie-k +ror protection from weather: Inadequate sewage or water facilities. Pest control Used? Yes ❑No Company Name: Frequency: Hotel/Motel Business License?KYes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected: pl -2 • ao Comments: I` S c _ ,- " rro ✓wi All violations in rooms not inspected must also be corrected. All re-ins ections by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: lee Environment ealth Spec' , Phone: Page 1 of .Dewy a,rw; coq - `/G SS -31155 EHD 24-01 4-30-12 HOTELIMOTEL OR