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N, SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT i� �;.ki ' '` ,, 1868 East Hazelton Avenue, Stockton, CA 95202-6232 qTelephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd OR'�`� HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: � Inspection Date:. Address: n N I CCT W,,(I -TI l/1 PE-,2quf PR#:c) (t 1 Owner/Operator: T&L �>�/� �� Phone: nnual Inspection ❑ Complainj Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: AGO#Units Inspected: ID 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, 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. ❑ 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). ❑ 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. ❑ s 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. 2,23— Other ,2 —Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lac 0—MW&XICAVti 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate tA — M(rIl i' 6p) J protection from weather: Inadequate sewage or water facilities. Pest control Used? Yes ❑ No Company Name: Frequency: Y1 L u Hotel/Motel Business License? Yes ❑ No lvffi Multi-Jurisdictional Violations to 6e Referred to: ❑City Building/Code Enforcement/Fire❑ County Code En rcement/Fire❑Other Rooms inspected: ) i. (( t� . n' ( M 0 M, Comments: — - we w -- iV�oi v_Mwi�, ory-1 + s c yeely- `In iD rxf 1 y f All Iviolations in rooms not inspected must also be corrected. All re-inspections by the Environmen a men wl11 Be i e a e current hourly rate. Received By: : Title: Environme th Specialist: ) l Phone: Page 1 of "4y' 11 _j EHD 24-01 4-30-12 HOTEUMOTEL OR