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�o�qa o 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.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: z/ Inspection Date: Z/7/Zo Z3 Address: 33 I D �S N, /'l S O `Y1 Q PE: Z PR#:O2 oo 6?_ Owner/Operator: Q a,� x ��! Phone: (S/0) �p _1O 2_ Annual Inspection El Complaint Inspection El Consultation Inspection ElRe-inspectiono #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): ❑ 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 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. 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. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate F16. 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. o e Yank ❑ 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? X Yes ❑ No Company Name: Tf--V IK e--).( Frequency 77t[ti� Hotel/Motel Business License? es ElNo L/ We Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: Comments: VeXonrle_ ✓ Veviecie ov peyri,T All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: f` Title: �rK� p v Environmental Health Specialist: /lI' Phone: (�)S,7' . ?V0 Pagel of , V(.t �l EHD 24-01 4-30-12 HOTEUMOTEL OR