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iPg��y SAN JOAQUIN COUNTY s`• ENVIRONMENTAL HEALTH DEPARTMENT 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: / Inspection Date: O _ Address: J 'I e p'l Na P I' P #: r Owner/Operator: W Phone: ;�I Z y nnual Inspection El Complaint Inspection E] Consultation Inspection E] Re-inspection #Units in Facility: So # Units Inspected: r— 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-1 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). ❑ 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. ❑ 7" Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other publicly shared spaces. ❑ 18. 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 'e ❑ ! 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: a Frequency: Hotel/Motel Business License? M*es ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected: Comments: ;-w /h / 44 /a 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: j rX z9�� Title: Environmental Health pecialist: Phone: 6 Page 1 of EHD 24-01 4-30-12 HOTEJMOTEL OR