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dpp__� agCLV 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 FOR`' HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: U Inspection Date: 3 13 Address: lisofbor—a PE�q I� PR#:u � 6a n Owner/Operator: k_ + Phone: 20q , q 2 _ 2 jqj [& Annual Inspection Complaint Inspection ❑ Consultation Inspection E]Re-Inspection6 # Units in Facility: i # Units Inspected: 13 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- F-] 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: Mattresshinens 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? Z Yes ❑ No Company Name: r<nj OS Frequency: Ge D' Hotel/Motel Business License? Q Yes ❑ No So 2 Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: Comments: CjAam 0—d' ,. All violations in rooms not inspected must also be corrected. All re -inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: h c' Gi yflckh� Environmental Health Specialist: (� ` , _ Phone: 20 _ __3q .� Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR