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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT (¢ `l 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: Inspection Date: Address: / '� PE` PRd Owner/Operator: x-171 /, Phone: ' plb n Annual Inspection,❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: y # Units Inspected: S Reinspection On or About: Arl 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): T❑ 1 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. 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, i 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). ❑ 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 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: ;S Frequency: yj-,., 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: Z �� Comments: ,, I r V10 All violations in rooms not inspected must also be corrected. All r ins ections bt the Environmental Health Department will be billed at the current hourly rate. Received By: " l Title: Environmental HeAl Spe ialist: ' Phone: _ Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR