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.,c"MIV. SAN JOAQUIN COUNTY :y ENVIRONMENTAL HEALTH DEPARTMENT t:: ►.� 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: Address: PE: P G3 Al W/IS o., Wel 41c z aoz Owner/Operator. ePQi>e h d ti tt f Phone' Annual Inspection ❑ Complaint Inspection ❑ consultation-inspection' onsultationInspection ❑ Re-Inspection #Units in Facility: So # Units Inspected: 5' 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,1 garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2. on-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). q ( ) 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 i 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? SYes ❑ No Company Name: k �, P,. Frequency: /f,(gf,, / 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: o // Comments: Qzle, ;� All violations in rooms not inspected must also be corrected. All reins a ions b the Environmental Health Department will be billed at the current hourly rate. Received By:), S • Title. Environmental Health Specialist: Phone: > Z Page 1 of f EHD 24-01 4-30-12 HOTEUMOTEL OIR