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, Q� y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. sigov. org/ehd CiFo'ik ' P HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: n Inspection Date: Address: 1 .30.E S`, W� Ic-or! Wtt r SJ P n PE� / 7 PRD d9 7 Owner/Operator: V "Qex2L4 ri �� Phone: pd// ,— If9672 Annual Inspection ❑ Complaint Inspection E] Consultation Inspection E] Re-Inspection7 # Units in Facility: # Units Inspected: S Reinspection On or About: A/l 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- F1 2 functioning sink/toileUbath; 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) . ❑ e 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 ❑ 1 D. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities . Pest control Used? X Yes ❑ No Company Name: lLf Frequency: M, Hotel/Motel Business License? fW Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : Comments: AW 0 DY All violatio s ' o0 of inspected must also be corrected. I re-inspections b e Health Department will] be blIjed at the current hourly rate. Recei Title: 1714". xjv t A� Envir n ental FjtM Specialist: Phone : ;I \ �-(l p) Page 1 of ! EHD 24-01 4-30-12 J 't ttOO HOTEUMOTEL OIR