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p,q�!ry 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 �lFOR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: Inspection Date: 5Is Zz. Address: v513 '�ICUIi'1(;� V �5 PE.ZAq PR#:V2yal Owner/Operator: A t ^V\V0 Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: , #Units Inspected: L1 Reinspection On or About: The items checked below are violations to be corrected. '3 See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): N¢ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, 'i0 garbage, combustible items or similar materials. Room Maintenance:General lack of repair or improper maintenance; Broken or non- 57,4 -OvAeA, 50a j-.VpwA functioning sink/toilet/bath; Lack of hot water. Floors: Not clean,properly covered or in kms% c� ��OZ 2 good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water '41J `i 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 ❑ 10. 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: CcD C� Frequency: Hotel/Motel Business License? 9Yes ❑ No To ZZ- Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: f53 uj b� ab �4� kLwt 10i,ftj, 3T ;, Comments: ? °I 32 2�i t; . .a IA3' 3 d S'43a' 311 Lkpdr-Q;s test byDo v O i 3& Allviolations in rooms not inspected must also be correcte . All re 'h pectI14 by the Environmental Health Department will be billed at the current hourly rate. Received By: I Title: Environmental Health Specialist: Phone: MCkTPage 1 of v 1p 10 EHD 24-01 4-30-12 HOTEUMOTEL OR