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P4 • y, 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 9 � IFOR�'�p HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: (�-� K fo ,r Mv � Lr '00T n J Inspection Date : jO[ l3 / Address : 1333 l• � 1 . tAn (,1� f � Il c� r JiW PE : PR#o j (q() 0 J Owner/Operator: &I ' / re I'� nw Phone : 0)/0(� p2 _/ �VT/S - Annua ( Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection[ 4 # Units in Facility : 3 # 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 . Room (s ) : Room Cleanliness : Lack of cleanliness & sanitation ; Accumulation of debris , trash , G�t�1Vai•� nv1 1 garbage , combustible items or similar materials . l � g 33 3y L3Z Room Maintenance : General lack of repair or improper maintenance ; Broken or non- 2 $ 1 '�YGcG+n � 2 functioning sink/toilet/bath ; Lack of hot water . Floors : Not clean , properly covered or in V G�tk Vbe Cir i good rLr �- repair. Walls & Ceilings : Wails/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 tiS 5 * foul matter; Unsafe ; Linens not changed weekly or before new guest . ZyL2S i +4 SI> eet.S ❑ Garbage Receptacles : Inadequate number of garbage receptacles ; Lack of or inadequate 6 , 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 . G�� s 32 Lf ZZ ❑ 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 ? XYes ❑ No Company Name: c � Frequency : /106AWLe Hotel/Motel Business License? N Yes ❑ No (� 2 Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : �S 1 20 2 3 1i 22S 7X Comments : G r (ti 1 re N► �1. Fil h^ w0ioali ChW ? ' t�✓i r>'= colla e' P nr All violations in rooms not inspected must also be corrected . All re-inspectiq s b t1hp Environmental Health Department will be billed at the current hourly rate . Received B 1 - Title : Environmental Health Specialist: _ /_ ( C I� ; Phone : 09 6V - - ZGi Page 1 of EHD 24-01 4-30- 12 T � / HOTEL/MOTEL OR