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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 y' Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd P `''FORS HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: L Inspection Date: Address: / 0�— 7�+ o� a G PE- / PR#- O D Owner/Operator: �.1 Phone: Annual Inspection 0 Complaint nspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: #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. Roorn(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- 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in Gtra ,bl�q 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? AYes ❑ No Company Name: equency: Af o,t 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: Comments: IIT=tis i r s not inspected must also be corrected. All s ecti ho al Health De artment will be billed at the current hourly rate. Received By: I � Title: Environmentbf Healt ecialist: Phone: 2 Page 1 of EHD 24-01 4-30-12 HOTELIMOTEL OR