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AgVIN SAN JOAQUIN COUNTY x°;fir'-.o z — �— ENVIRONMENTAL HEALTH DEPARTMENT .z 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: ev— /'le) Inspection Date: Address: 7� A // D �r-2�� PF !L//_ PR#�; � Z Owner/Operator: Jni Phone: tp �J Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: .,Z #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. ❑ s 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 l ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate Protection from weather; Inadequate sewage or water facilities. — Pest control Used? KYes ❑ No Company Name: ��A Frequency: 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: Oy p 3 n 47 Comments: of All violations in rooms not inspected must also be corrected. All re-ins ections by the Environmental Health De artment will be billed at the current hourly rate. Received B Title: Environmental Health Specialist: Phone: f/— �'�� Page 1 of EHD 24-01 4-30-12 D HOTEUMOTEL OR