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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.siqov.orq1ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: _-Address: PE: PR#: 5794', Owner/Operator: hone: )64w. 7P letl'o #units l Annual inspection El complaint,inspection 0 Consultation inspection El Re-inspection #Units in Facility: I Inspected:s p e c t e d: A I Reinspection On or About: 3d ......❑. ...... ....... The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summar t2f violations and Code References, Room(s): Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, garbage,combustible items or similar materials. 7A ;_5 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, ❑ 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 i (multi-use)or individual protective wrapping(single-use). ❑ 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, !L I ❑ � Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 6* close f�ifting 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, ED F9. Other Nuisance:Any other condition which is hazardous to health, Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack El 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? XYes [I No Company Name: alqpK Frequency: Cyt N! 1�y Hotel/Motel Business License? 0,Yes [] No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire E]County Code Enforcement/Fire❑Other Rooms inspected:�W3 4, Comments: I I IL j T4 Em L4 +h L fz-.o 0 jr:3 6v �A,_ CQ4 *ass t All violations in rooms not inspected must also be corrected. -,-,Ali re-inspections by the Environmental Health Department will be billed at the current hourly rate. Receive cVW- - - Title: Environme661 Health Slie-cialist: Phone: LLeq q'NI)4�— I Page 1 of ( I EHD 24-01 4-30-12 HOTEUMOTEL OR