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a>y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ?:' •—ter.-- . •.x 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd _ P HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: �n�+ n�Cr) n mo a Inspection Date: Address: a�zz o QA fl11 A 1C,.1/ C.�� qV�ki E: r Op PR#: Owner/Operator: I� n Phone:to _ I _4-7a ^ �� Annual Inspection ElComplaint Inspection ❑ Consultation Inspection E] Re-inspection #Units in Facility: I #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): ❑ 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. 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). Drinkinq 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?77es ❑ No Company Name: EC&L,,k Frequency: 0,jq Q Q 11 Hotel/Motel Business License? D<Yes ❑No Multi-Jurisdictional Violations to be Referred to:❑ City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑Other Rooms inspected: pq Z- Z} 3 S '� S Zoo L o2 2 Comments: o 0 WrX1 ''0 &t • f e ve exf�71 (A iter o O Xo_)( For of aC-< 0 -e-Irm c ko o Pf-vo,& e All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: e jqeisi-du Title: tR pd,Our— Environmental Health Specialist: ('� LL t x,.. Phone: � L Page 1 of EHD 24-01 4-30-12 �� HOTEUMOTEL OR