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q,,,,y SAN JOAQUIN COUNTY P Q.a�t, ENVIRONMENTAL HEALTH DEPARTMENT {' 1868 East Hazelton Avenue, Stockton, CA 95202-6232 `•'bia Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Dater Address: [� ZG K G I I(sv0` W PE: l PR# Owner/Operator: Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: I- # 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): ❑ 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- F] 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. ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, 3. 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). ❑ 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. ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate close fitting covers; Garbage receptacles unclean or in disrepair. 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: ' Rt—iK4 I Frequency: Hotel/Motel Business License? XYes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: • o2 0 1 p7 115 Comments: 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: , '�^ Title: Environmenta alth Specialist: Phone: e��,�r,3 rLs� Page 1 of EHD 24-01 4-30-12 ` L HOTEUMOTEL OR