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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 4�''-F�•R�`�� HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � e rn 7( Inspection Date: Address: 0 5 �Ar I S U 7t Owner/Operator: S /Z Phone: nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: # 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- F-1 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). ❑ 5. Beddin : 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. Fr Pest Control: Infestation of insects, vermin or rodents. ��tUj Vo-c es ❑ 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? es ❑ No Company Name: Frequency: '71 6Mth I Hotel/Motel Business License? pityes ❑ Nov c,J Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: j 0 C) Comments: (i „0 Ke etectc)6 U Ve eX w�Sh�rS obs� VV�� Z All violations in rooms not inspected must also be corrected. All re-insppctWns by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmental Healt pecialist: L one: 2p Q Z ys Page 1 of EHD 24-01 4-30-12 <�S �G� HOTEL/MOTEL OR