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apq�ly SAN JOAQUIN COUNTY 2; _._err-, •.�.'R, ENVIRONMENTAL HEALTH DEPARTMENT ' 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd � he—�R��p HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � ' Inspection Date: Address: b04 , 1 V4 i (w�N Vq 6 Cin, fPE:2'f 11 PR#:�2 rl Owner/Operator: P� Y � ma� Phone:sp _22 _qc% Annual Inspection Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: if #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): ❑ 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. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, ❑ 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 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 101,N~>JP,p 'I'K-X-Q- [ 10. of or inadequate smoke detectors or fire eA-n_gu-i_sfi-elT, Inadequate lighting; Inadequate IUB -(CCQ,�IV � ° � protection from weather; Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: Frequency: Hotel/Motel Business License? Yes E] No Multi-Jurisdictional Violations to be Referred to:❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected: j 0-2— 15 I 1 Comments: •- YYI S a. VIS All violations in rooms not inspected must also be corrected. All re-ins ections by the Environmental Health Department will be billed at the current hourly rate. Received By: 1 `J ,'\D . Title: t , G n Environmental Health Specialist: Phone:ELM hici-4 �ss Page 1 of EHD 24-01 4-30-12 L• HOTEUMOTEL OR