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r-OL; 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 �lFOR�` Name of Facility: �'n 1�y� Inspection Date: ` : 11 ww t�4 `^I l ' 1n nl p Address: ' W O V`�1`S�I t UI 2 O 5 PE:241�- PR#: U Z O D 0 Owner/Operator: NMI I �( 'y f I Phone:Q,09-) 2217 Annual Inspection [:] Complaint Inspection [:] Consultation Inspection ❑ Re-Inspection D 1 # Units in Facility: #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, 1 garbage,combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- U� �� SWVAJQ_r functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in \fie Om. b � 2. 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). ❑ Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or 5. 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? K Yes ❑ No Company Name: R Frequency: rl Hotel/Motel Business License? N Yes ❑ No ©cj Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: k '6 051 10 c I ( \f� Comments: or rz� All vi lations 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 B Title: Environmental Health Specialist: - EHD 24-01 4-30-12 Phone:l [ �J� Page 1 of HOTEUMOTEL OR