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Pq�l.y SAN JOAQUIN COUNTY e EN' ONMENTAL HEALTH DEPARTS AT lw� htfi `I 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: y Inspection Date: ,fly 7�/1/ "7 �es7��r7 �'ri�tc '2 �F•�_ � Address: PE: PR#•- //I E � 'g'-CA Com. _ 2y,:T 0;?_1_/0/ /SF Owner/Operator: r Phone: - �4nnual Inspection ❑ Complaint Inspection ❑ Consultation I pection ❑ Re-Inspection # Units in Facility:-2,0!Z i # Units Inspected: i'Z Reinspection On or About: N A. The items checked below are violations to be corrected. See Reverse Side of this Form for Detailed Summary of Violations and Code References. Roorn(s): ❑ Room Cleanliness: Lack of cleanliness&sanitation; Accumulation of debris, trash, 1 garbage,combustible items or similar materials. 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 (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 El10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? Ryes ❑ 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: '7 '25 Z 2-�� ;Z 2 �' © Z��( Z Comments: -2,*)-2- -+, t --IL ry •.: -.,5 •f'6 J"C. --to Frl2 -P-t lc--t All violations in rooms not inspected must also be corrected. All re-inspections b the Environmental Health Department will be billed at the current hour) rate. Received By: I)' Title: Environmenta Health Specialist: Phone: / 3 t`�'S-:-Z Page 1 of f EHD 24-01 4-30-12 HOTEL/MOTEL OIR