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oPQ�,y 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 ;Ji 0. HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: ) 'ow Inspection Date: Address:L i, '1 n — �7� L PE: Z PR#:- 2 Owner/Operator: �Ck �-O 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 - SI tc,w�K functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in Z' 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. Heating: Lack of approved heating in each unit; Approved heater not maintained in a safe, ❑3. 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. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate ❑ 6 close fitting covers; Garbage receptacles unclean or in disrepair. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other ❑ 7. 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? K Yes ❑ No Company Name: Frequency: ' Z 6L Hotel/Motel Business License? ❑ Yes M No r 1 ) C' Multi -Jurisdictional Violations to be Referred to: ❑ City Building Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: 2pf\5'. 3 Comments: rdAarr M1/ \ �n L .yo All violations in room not inspected must also be corrected. All re::inspection5, re-:inspectionby the Environmental Health Department will be billed at the current hourly rate. Received By: /_� � Title M Environ tal Hea'[tF Specialist: Phone: •11 t� ` Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR