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r- 4 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 P �!FORHOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: 'Lft N U I V"N Inspection Date: 2X I Address: 23�3 Gcond cow �1 PE:2u�L1 PR#: 024 6))(o Owner/Operator: L1*14 p ni s , r� �,. e- Phone:`'D -0191 -909D 019 -9n I9 Annual Inspection ❑ Complaint lnspe i n ❑ Consultation Inspection ❑ Re-Inspection 1 V 1 #Units in Facility: # 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- ❑ 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 F-1 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. 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: FFrequency: Hotel/Motel Business License? Yes ❑ No ct Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected: S 515 S 2 5 5 3 2,(© Comments: 30 5 3el. lks 10 1 o via �bs�ry (� E I solations in rooms no ' spected must also be corrected. All r -'ns ections by the Environmental Health Department will be billed at the current hourly rate. Received By: Environmental Health Specialist: Phone: �� 1 C &EV * 7 -APage 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR