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PquIN SAN JOAQUIN COUNTY Yo. � .co00 ENVIRONMENTAL HEALTH DEPARTMENT a: . 0 " d< 1868 East Hazelton Avenue , Stockton , CA 95202 - 6232 Telephone: (209 ) 468-3420 Fax: (209) 464-0138 Web: www . slgov . org /ehd Ct •. • 1 ; .• P Fs0 � HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility : Inspection Date : � C'L� (GVCF INN �6 ZS / y Address : 1 :-030 JV rite loNT JPT: xio & Kmpi PENS PR# 1 V2y100 ! : Owner/Operator: C #M,0A 9Z1Nr Iol" CL, Phone : fro KAnnual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re- Inspection # Units in Facility : # Units Inspected : It 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) . F-1 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. ❑ Public Areas: Unsafe or unsanitary conditions in kitchen , hallways , stairways , exits , or other 70 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 ❑ 100 of or inadequate smoke detectors or fire extinguishers ; Inadequate lighting ; Inadequate protection from weather; Inadequate sewage or water facilities . Pest control Used ? , . yes ❑ No Company Name : j91W Frequency: 014 L }1 61,44 Hotel/Motel Business License? ❑ Yes ❑ No Multi-Jurisdictional Violations to be Referred to : ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected : / 0 105 , / p / lO / 4 // V, // 3 ) Z / 0 Comments : # /O / - lace P/at47 coverrIgle be fiNo Tv CCAble ngvw lmaywo ivm,(� nnF IF OZ - Ni/i1CyV 017"Iy6t ' ,6/P/M.F00/7 6FFFC7L if Nfi - HYN104M w b ltr G rV46- co V410 /s Z1VA';67j f // 4FF- r'�rr f ,l ticT bW/f., pJ c (F#MCG ,rqo . ,oC7& 70111. All violations in rooms not inspected must also be corrected . All re- ins ectio s by the Environmental Health Department will be billed at the current hourly rate. Received By: - Title : Environmental HIbalth ecia ist: I Phone : :��_ Page 1 of Z 1 EHD 24-01 4 -30-12 HOTEL / MOTEL OR