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o'4ur`' c SAN JOAOUINTY �.• •.o ENVIRONMENTAL HEALTH DEPARTMENT �t. 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax: 209 c ._�.._. .•P ( ) 464-0138 Web:www.siaov.ora/ehd HOTEUMOTEL OFFICIALS INSPECTION REPORT FAddress: lity: t3uDUE-T I/•in1 9, tl-'UiT�/'- OF vzi��k� ti Inspection Date: 06/ho ,.j�-3 YJ f MME Q t.TJ . AGK TOn1 PE: V O PR#: Owner/Operator: gll,4E (bt"�L C Phone: ❑Annual Inspection Complaint Inspection ❑Consultation Inspection Re-Inspection # Units in Facility: # Units Inspected: 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 Djbot water. Floors: Not clean, properly covered or in good repair. Walls&Ceilings: all eilings in need of cleaning or repair: Holes,water damage, peeling or deteriorating paint; Dampness o xce"s�1Ve 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). 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? ❑ 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: 10,1�, //0 I Z-4 & 12g Comments: �D 6,VbS 11Q R-00 1E f 10.f //0 /L} JZ 128. C oti&a 1 X1' /LffnvCio oli CT ;y X13 M40 /o i �- 2013, C014106 ,k/T i�/✓P��yiv,�,c/ Conrput,_r1V UN Oe 23 Itoo /A)O 12Y)2-043 Ct9Nf/2N1' /W fit 5iclj4e 9f r6i—o GUe-j; 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: br- yPage 1 of�'I�,i3 EHD 24-01 4-30-12 HOTEL/MOTEL OIR