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o0.q�l►�, SAN JOAQUIN COUNTY 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 of Facility: Inspection Date: Address: PE: —pk#: 9f 17GrS- Owner/Oper tor: P one: —/ ®Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re-Inspection #Units in Facility: 3 2L #Units Inspected: - _5 On or About: Al 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, VD garbage,combustible items or similar materials. -A 3C61*_103 Room Maintenance: General lack of repair or improper maintenance; Broken or non- ❑ 2 functioning sink/toileYbath; 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). Bedding: 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. 7.❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other publicly shared spaces. E❑ 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? es ❑No Company Name: eA_1dyW Frequency: t Hotel/Motel Business License? f5KYes ❑ No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: ( � J 5 #-3-0-5 ZI Comments: /V0 S All violations in rooms not inspected must also be corrected. All re-ins ections by the Environmental Health De artment will be billed at the current hourly rate. Received By: / ---- Title: Environmental Heal Specialist: (' Phone: J Page 1 of r EHD 24-01 4-30-12 �+^ HOTEUMOTEL OR