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Pq� ry SAN JOAQUIN COUNTY /ter/. La ENVIRONMENTAL HEALTH DEPARTMENT ; cF 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: a �f � l� Address: +� � Inspecti n Da �� PE: PR 1A/ c b✓'' Y�/ -19c�n-I � v 6 Owner/Operator: ;77 ff e fK. L( Phone:` 41 � e2 [5 -Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection Re- nspection # Units in Facility: # Units Inspected : LL Reinspection On or About: pt / 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- El 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. _ ❑ 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? Wes ❑ No Company Name: £ / quency: n.1rWI C 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 : ) 67 tG \ ' I Comments: f X10 AA All violations in rooms not inspected must also be corrected. 'YAII re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received, B Title : Environmental Healtfl Specialist: v Phone:% \ I" ). _G'A1t Daye 1 of EHD 24-01 4-30-12 HOTEUMOTEL OIR