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oP4,,,y o 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 OR� HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: // D/ j� Inspection Date: y/301/.S Address: 23/2�3Kt�'J.�.ut C2usQ ��v�f� PE.�� PRS D// Owner/Operator: Phone: 9.5 7 0 C 0 Annus Inspection El Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection # Units in Facility: /4)8 # Units Inspected: Reinspection On or About: -rhe 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. on- 2 functioning sink/toileUbath; 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 ❑ 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate protection from weather; Inadequate sewage or water facilities. Pest control Used? gYes ❑ No Company Name: j5j�otaFrequency: 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: /02 /4// 2J�2 2 Z3 1 Z Ze5 1 (, Comments: Alo aL 1 All violations in rooms not inspected must also be corrected. All re-inspections b ;)the Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmental H661th Specia(i : Phone: Page 1 of EHD 24-01 4-30-12 HOTEL/MOTEL OR