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oP4"!N SAN JOAQUIN COUNTY .y ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd /FORA HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: t3J)017E_T 1Ntil S' V_W rE.l-. Of 07V CK PDA) Inspection Date: Address: 34fi3 yJ fi{hA0E(L I.N . , V-)O(KTO►J PE: Owner/Operator: lit l,lpjj[_�t_ pc Phone: ❑Annual Inspection XComplaint Inspection ❑ Consultation Inspection Re-Inspection # Units in Facility: # Units Inspected: q 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 clean iness&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 f hot water. Floors: Not clean, properly covered or in good repair.Walls&Ceilings:GlIeilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness oess oexcesWe 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). .14 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 ❑ 1o. 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: Frequency: 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: 109'/ 1/0 12,4 A 128 Comments: 5o ISUbS lnt /Looms f /(),!Fl //0 IL} /28. ( O"aa wir REzc►uc-o ON or� ,-112,013 /? ID lv i ?- 2o)3 - CD/vIPc n!T 1nJ✓'11fe:7joAAf OoNDucrco opt/ 3 t:J) fi�,)o 2y 2-00 C-04 /1T✓r' . PIC 1/16C_)juE of ,Kzb dpk- . 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 Health Specialist: Phone: ,jb J 9, Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR