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f. SAN JOAQUiN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 =ku Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sigov.org/ehd ..7 , ! HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: inspection Date: f�!f�vr� ��r��n ✓� ll C+__ P PR Address: X3.2 Cir-...��.0 Lr'•x.s�-t' 1v ce Phone: 9:5--7 " 'F0 ?0 Owner/Operator: - _ aAnnuai Ins ection_ Complaint Inspection ❑ Consultation Inspection Re-inspection _ #Units in Facility: ?,r # Units Inspected J Reinspection On or About: The items checked below are violations to be corrected. R_o_onn(s): See Reverse Side of this form far Detailed summary ofviolations-and Code References. ---- - -- Room Cleanliness:Lack of cleanliness&sanitation;Accumulation of debris,trash, ❑ t. garbage,combustible items or similar materials. Room Maintenance:Genera!lack of repair or improper maintenance;Broken or non- 2 !functioning sink/toilettbath; Lack of hot water Floors: Not clean,properly covered or in good repair.Walls&Ceilings:Wallslceilings in need of cleaning or repair:Holes,water ((( damage,peeling or deteriorating paint;Dampness or excessive moisture in room_ Heatin :Lack of approved heating in each unit;Approved heater not maintained in a sae, ❑ 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). 7 El Beddin Mattress/linens infested with lice,bedbugs,or other insects; Not free from fifth or : foul matter;Unsafe; Linens not changed weekly or before new guest. ❑ 6 j Garbage Receptacles: Inadequate number of garbage receptacles;Lack of or inadequate I 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. I Pest control Used? US Yes ❑ No Company Name: 6c c1,-6 Frequency: M o.,oV l 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: -gZ_3 73 i, 7 •f,, a'r t t ` Comments: All violations in rooms not inspected must also be corrected. All rfik4rispections by the Environmental Health Department will be billed at the current hourly rate. Received By Title Environmental ealff Specialist:. Phone: ,i� _fr ? �„�', Page 1 of !1 'T��S ..' E-MAH FL OR EH024-Oi 4-30-12