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➢-Q• fY. 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 HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � �� Ga � V T 71 Inspection Date: Address: 1 '3_5s s E �. �y �r r,- PE: PR#: Owner/Operator: N/� t_ y��C`h �' ,�\ � �� Phone: )q 10 v`�! J�1, �'`09l 7 O z—s1 ss Annual Inspection ❑ Complaint Inspection ❑Consultation Inspection ❑ Re-Inspection #Units in Facility: #Units Inspected: In IReinspection On or About: Z 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, a 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. ❑ 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: r Frequency: Hotel/Motel Business License?.PK-Y-es ❑No D Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected: 13 9 . 3 �Z Comments: e- c 0 k - li o �, Kr- �-t e�- � ,)A e _ All violations in rooms not inspected must also be corrected. All re-ins ections E vironmental Health De artment will be billed at the current hourly rate. Received By: Title: C)(�'/) Environmental Health Specialist: Ili one: �9�/ l�� SI� page 1 of EHD 24-01 4-30-12 S ( r _ / ( HOTEUMOTEL OR