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oP41'N. SAN JOAQUIN COUNTY ENS, DNMENTAL HEALTH DEPARTN 1T ,N m 1868 East Hazelton Avenue, Stockton, CA 95206232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd meq`=FORN�P HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: /�l c,f` ./�7�� Inspection Date: �l7 11 t Address: PE6,11 7 : PR#: Owner/Operator: —� - Phone: r- _ 'Annual Inspection Complaint Inspection ❑ Consultation Inspection ❑ e-Inspection # Units in Facility: # Units Inspected: Q" Reinspection On or About: PIX 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. HooI .s,water llama peeling or deteriorating pain ; ampnessor 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: 707 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). F7 5. 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. ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits,or other 7. 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? Yes ❑ No Company Name: J �ij.,�:, Frequency: lv(p4,� i Hotel/Motel Business License? Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: •21 Z, f ZI Z� Zv L= ✓ 2- Comments; All violations in rooms rwt inspected must also be corrected. All re-ins �cti s by the Environmenta ealth Department will be billed at the current hourly rate. Received By: ^ Title: Environmenta H alth Specialist: Phone: Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OIR