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SAN .JOAQUIN COUNTY OPQu��. ENVISeNMENTAL HEALTH DEPARTME,.,,, 1868 East Hazelton Avenue, Stockton, CA 95202-6232 �•= F. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ghd HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: j t j s- Address: 6Z5� �wlh ST � PE:ay0cT PR#-02_q tj Owner/Operator: ,DQ.fir _ Phone: f�kAnnual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: #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): 01 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-1 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. ❑ 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 vzw%ZZ.Cs 134;4t^y 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from wea er; na equa sewage or water facilities.K) I Pest control Used? X Yes ❑ No Company Name: Frequency: t Hotel/Motel Business License? ❑Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code EnforcemenUFire❑ County Code Enforcement/Fire❑ Other Rooms inspected:%,0 Sy 1001 I a Z 11 li 1 6 2'2_ 'L 7-3 3 4 -L�cl 7S Comments: Z s L All violations in rooms not inspected must also be corrected. All re-inspections by the Environawntal Health Department will be billed at the current hourly rate. Received By: h- Title: r Environments a Ith Specialist: / _ _ Phone: �D Page 1 of EHD 24-01 4-30-12 HOTEVMOTEL OR