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GXL UV 11 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www,sigov.org/ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: -5 fib <br /> Address: PR#.ovioe>qLt <br /> owner/Operator. Phone: <br /> Annual ln§pection- ❑ Complaint Inspection El consultation Inspection E] Re-Inspection <br /> #Units in Facility: #Units inspected: p Reinspection On or About: 461. <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> El1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance:General lack of repair or improper maintenance; Broken or non- 5 AA it( <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in <br /> 2. <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes water V4V,- 5C.A-" <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> + <br /> 3. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> working condition; Lack of adequate heat(Standard:70°F at 3 feet from floor). <br /> Drinking Utensils&Ice Buckets: Not protected from contamination; Lack of or improper <br /> El <br /> 4. washing&sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping(single-use). <br /> F-i 5. Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate in.&I�-F-cs, ory <br /> 6. close fitting covers;Garbage receptacles unclean or in disrepair. <br /> -Public Areas: Unsafe or unsanitary conditions in kitchen, h I allways,stairways,exits,or other <br /> El publicly shared spaces, <br /> Pest Control: Infestation of insects, vermin or rodents. <br /> ❑ 9. Other Nuisance-Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack TZ vtj M%-[C> Z3 <br /> 7T,0-. lof or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> ?,VK <br /> protection from weather; nadequate sewage or water facilities. <br /> Pest control Used? ly Yes E] No Company Name: fli4j)r Frequency: <br /> Hotel/Motel Business License? El Yes El No <br /> Multi-Jurisdictional Violations to be Referred to: E]City Building/Code Enforcement/Fire E]County Code Enforcement/Fire❑ Other <br /> Rooms inspected: 112, IL41 1!�� I a�n 1 2 3 --2-,,4 <br /> Comment 1 <br /> A N k ..1 V%Z> <br /> yA0V-%0V_k__ pe>iM5 1'k-" &"P-s A­Zloim�3,4_%��Ly,%,e�- Ax <br /> u <br /> CAII violations in rooms not inspected must also be corrected. <br /> All re-ins pection!;b7tF-e Ervironmentat Healtn Depart-m-5`11117WIII Plea at Ina current hourly rate. <br /> Received By: Title: 6 /41 <br /> Environmental Health Specialief r Phone: ig, W 0-SS- ;L- <br /> I- Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />