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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT a I Now_ 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.crq/ehd �P HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: �L Inspection Da Addye 5: N� CWS to If uz PE: PR#: is ? 2Gf0p Owner/ er tor: ho G o � pho e- � T L ❑Annual inspection ❑ Complaint Inspection ❑Consultation Inspection EXRe-Inspection #Units in Facility: J # 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): ❑ 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. 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. 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 ❑ 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: Alid O L Frequency: Nl0 Hotel/Motel Business License? 1Yes ❑ No Multi-Jurisdictional Violations to be Referred to;❑ City Building/Code EnforcemenVFire❑ County Code Enforcement/Fire❑ Other Rooms inspected: )"2 I ) �) Comments: T4 S TU NSG hWI4& , v` �-171ml d �� Asks 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: , 9 Page 1 of j EHD 24-01 4-30-12 HOTELIMOTEL OR