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Pq!!t\ SAN JOAQUIN COUNTY Ap. ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www sigov orq/ehd ` - �4�/F`OR�%' HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: /y�- Inspection Date: / Address: - — -- _� � G�r�{ro� PE: PR��_S_�'^7 Owner/Operator: 7'�`� Phone: nnual Inspection ❑ Complaint Inspection [] Consultation Inspection ❑ Re-Inspection #Units in Facility: #Units Inspected: yZ.- I Reinspection On or About: The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summa 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. on- 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 (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: yam, Frequency: A,1 t � r Hotel/Motel Business License? Y Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: 3 Z-3 Sr 2 23 J1 7-+ 1 Z Comments: - 2 -7,0 c- (.0 Z-0� -Z t a Zit Za 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: �� •-�� j Z,_ Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR