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.OR II SAN JOAQUIN COUNTY 'o 77'CEN\ ONMENTAL HEALTH DEPARTN IT y 1868 East Hazelton Avenue, Stockton, CA 9520 -6232 Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.orq/ehd 4�1POR� HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: , /i_ Z-2 � � � Inspection Date:S A4 Address: 232/"3/i PE:Z�� PR#pZ�.0aa, Owner/Operator: Phone: 1:e.7 — go 90 Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: f 9 g #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, garbage, combustible items or similar materials. Room Maintenance: General lack of repair or improper maintenance; Broken or non- 330 " o ❑ 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. ❑ 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. 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? &es ❑ No Company Name: Frequency: 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: f(p7 2 :2 -3 3 3 3t 417A `j . f-4 Comments: ,r CSF i All violations in rooms not inspected must also be corrected. All re-4,sDectionslbv the Environmental Health Department will be billed at the current hourly rate. Received By: �I G .�1 Title: Environmental H alth S ecialist: Phone: -S.-2. Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR