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a la 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 P HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: SL_ r ei M o�f., I vi� Inspection Date::gk 3 J I Address: 11 3 3 3 1 E, I>- A&L-14 Jr g I vol . - — PE: cg, 1 7�4 01 t 0 3 Owner/Operator: <F_ e _ e AAe„esl�_!_�� Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-ln§pection #Units in Facilityp 7#Units Inspected: I 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): ❑ 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 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. ❑ s 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. 0 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? WYes ❑ No Company Name: Frequency: 44 * Hotel/Motel Business License? es ❑ No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire 0 County Code Enforcement/Fire❑ Other Rooms inspected: 17,5 Z 7Z Comments: All violations in rooms not inspected must also be corrected. All re-ins ecti ns t E vironmental Health Department will be billed at the current hourim rate. Received By: � Title: Environmental Health Specialist: Phone: Page 1 of EHD 24-01 4-30-12 a J HOTEL/MOTH OR