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Pq�r>y, SAN JOAQUIN COUNTY a• ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www,sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name ofFacility: Inspectio Date-I VY ' ANT t- A dress: PE: PR#: I 17-Z WW62� A0, !f?9N Owng��perat r: Phone: //77 4(? S e7 o _ 4 Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection D Re-Inspection #Units in Facility: #Units Inspected: 3 1 Reinspection On or About: N �' The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summwy 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- 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. ❑ 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. ❑ 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? 5jYes ❑ No Company Name: Frequency: 7W / Ty 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: Comments: ,tb Jr' ''Spr/ 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 Mealth Specialist: Phone: r p/ (a s Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR