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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 'l Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slgov.orq/ehd .......... F ..... HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: t�/ `p_ Inspection Date: 1 (, Address: i 5 V 0 61 e I I Q U t 1 9 1 I) W 1 PEj,6 J� P n Owner/Operator: a � 4, Q ll 166+ % i Pho 42 -'7 1 q 1 ' nnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re -Inspection # Units in Facility: --7#—Units Inspected: 3, Reinspection On or About: The items checked below are violations to be corrected. Room(s): See Reverse Side of this Form for Detailed Summary of Violations and Code References. Cleanliness: Lack of cleanliness & sanitation; Accumulation of debris, trash, El 1' garbage, combustible items or similar materials. garbage, on- Room Maintenance: General lack of repair or improper maintenance; Broken or non- 2. 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. Heating: Lack of approved heating in each unit; Approved heater not maintained in a ❑ 4afe,3'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 improp❑ 4. washing & sanitizing after each use (multi -use); Lack of or improper protective baggin (multi-use) or individual protective wrapping (single -use). Bedding: Mattress/linens infested with lice, bedbugs, or other insects; Not free from filth or ❑ b foul matter; Unsafe; Linens not changed weekly or before new guest. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate ❑ s close fitting covers; Garbage receptacles unclean or in disrepair. Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways, exits, or other ❑ 7. 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? WYes ❑ No Company Name: requency: 0 1 r '' Hotel/Motel Business License? KYes ❑ No 12-131 UZ,O Multi -Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: Comments: %0 r r r o. 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: 0cc;� y\ Environmental He Ith Specialist: Phone: — Page 1 of HO7 EL/MU I EL EHD 24-01 4-30-12 UIK