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a,CLU,y SAN JOAQUIN COUNTY r. - ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 ' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � C` _ / Inspection Date:� 113117 Address: [ p ZZ -SW �So� W0. �t PE I PR#j ©O I Owner/Operator: Nom. P ne. �3s_7 tv(OB Annus Inspection ❑ Complaint Inspection ❑ Consultation Inspection -Inspection #Units in Facility: 1'7- #Units Inspected: IReinspection 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. ❑ 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). 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). rEl 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. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate 6' close fitting covers;Garbage receptacles unclean or in disrepair. ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other 7. 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 W1r-ee protection from weather; Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: Frequency: µ4.0 44,f Hotel/Motel Business License? es ❑ No ZAk1j ga� Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected: 5 Comments: ss L W All violations in rooms not inspected must also be corrected. All re-ins ections by the Environmental Health Department will be billed at the current hourly rate. Received By:C, Title: S' All Environmental Health Specialist: Phone: � f-f Page 1 of ' EHD 24-01 4-30-12 HOTEUMOTEL OR