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otgvity 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.or /q ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: �� r�► _, Inspection Date: 4-Z Address: MAO N,. /Sdh &4j ct b�crGl�`��ti PE:zj�,/_ PR#: 6Z q&) Owner/Operator: /7 Phone: F Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: ?_O #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- 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. ❑ 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?,&Yes ❑ No Company Name: 406ttFrequency: Hotel/Motel Business License?,K Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: ©3 , / , // Comments: lim'1V l7e• 41?eV11- i, , t°,f'' PCO►�� a•'�. � i`sem-E= /'�.�,►r All violations in rooms not inspected must also be corrected. All re-i pe 'ons by the E on tal Health Department will be billed at the current hourly rate. Received By: ( ILIt-✓ Title: .P►�' Environmental He pecialist: ^OQ�Q ,^ do Phone: ✓ 3c� Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR