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qu�N SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT N �I 1868 East Hazelton Avenue, Stockton, CA 95202-6232 �C•. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd ,777R7 HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: f)�7rf t,� , Inspection Date: a3 +nG /y Address: SSO rV AM• MIXnN LUr"IIM tiIM,6 J i1 6wlJ. PE:Z40S rR02Wo9y Owner/Operator: L//7'rwP +m- /hrrCz 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): F1 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). j 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. j 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: NVI/A//X Frequency: ?y n U 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: is/ <-o )y6 131 Z J Z ? G Comments: /411- v ✓H m 6o Lwvcr 6cyhi aoo/i- 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: Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR