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Ag 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 . or /q ehd two to a HOTEL/ MOTEL OFFICIAL INSPECTION REPORT Name of Facility : rest t �7ee e Inspection Date : OCA Z. •Z c) Address : `, � /, ' sor � J � Y � DGAto 'YL A MotPE L ' i PR#: Owner/Operator: � Phone : ry ' /' iz t31 e4 Ck, Annual In pection ❑ Complaint Inspection El Consultation Inspection El 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 ) : El 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 - functioning sink/toilet/bath ; Lack of hot water . Floors : Not clean , properly covered or in 2 ' 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) . Drinkinq 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 . ❑ 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 13i) U Ke. 10 . of or inadequate smoke detectors or fire extinguishers ; Inadequate lighting ; Inadequate h I �S j ry'1 protection from weather; Inadequate sewage or water facilities . Pest control Used ? es El No Company Name : G v No Frequency : th Hotel/Motel Business License? es ❑ No (,n tf to "t, Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : ' Comments : Fool fate C41 7� 44e 63 e rvecf CA A;r All violations in rooms not inspected must also be corrected . All rep spections by the Environmental Health Department will be billed at the curlp,.nt hourly rate . Received By : �i ` Title : r Environmental Health Specialist : +a�`•LI�� Phone : !d ._ C . Page 1 of to 11 f , (•+J HOTEUMOTEL OREHD 24-01 4-30- 12 ,J�q r