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ppq�� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT w' 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.si-ov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: U_ Z� x� Inspection Date: 1 15C t(i n� t Address: l 0 �S N. Z SO'n W 0. O� P yob 62 oos Z Owner/Operator: - Phone: �,C � S 'h,a-�. �r b 3t a c Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: 1112 1 #Units Inspected: ff I 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/toileYbath; 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. ❑ 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. oy- 8. Pest Control: Infestation of insects,vermin or rodents. ahtiv� bea b04A-) dle�c.4 ❑ 9. Other Nuisance:Any other condition which is hazardous to health. Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack - SrVICV e 4e4�{�.� V10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate h o) protection from weather: Inadequate sewage or water facilities. J Pest control Used?7 Yes ❑No Company Name: Q j(.yvt_4 x Frequency: p --f A 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: 03 , Comments: I(a — d C tips Kfm,02 c Jeick 2 S X4252 6 ^SSG 1 O C_ V1_ C�✓�I 1') kj 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: W-711441 - � Title: t-,j"/-Y-- Environmental Health Specialist: ,,, (2 rv1 N., Phone: Pagel of EHD 24-01 4-30-12 D HOTEUMOTEL OR