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y o 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.org/ehd %FaR�'A HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspectio Da cy*i ,1110117 Address: N PEPR#: 11 H'0 tti',%L Un/ AMY _ kw Zd j 7'Y� f Owner/Operator: L Phone: N'" 2 Lt62— U63 [ZAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection El-Re-Inspection # Units in Facility: #Units Inspected: 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- functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in ❑ 2" 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. F] 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). ❑ b 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? 0 Yes ❑ No Company Name: ; % requency: Hotel/Motel Business License? 0-Yes ❑No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected: 6-Z-*t-I -3 W'-)p - l tp Comments: Nd Cit, / All violations in rooms not inspected must also be corrected. All re-inspections by the Env'ronmental Health De artment will be billed at the current hourly rate. Received By: Title: Environmental H Specialist: Phone 4i Page 1 of EHD 24-01 4-30-12 HOTFUMOTEL OIR