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o �!n SAN JOAQUIN COUNTY xg .o ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd �lFOR`' HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility:. _ I 1 1 Y,l�' 4 `1"l,�arricA Inspection Date: Address: 2 W feY , 1011 PE-.2 I PR#: 0 77— Owner/Operator: SarPhone:k � h Z-YO QLD Annual Inspection ❑ Complaint Inspection ❑ Consultation inspection ❑ Re-Inspection #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): 1 Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, i aL 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). ❑ 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. Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate ❑ 6. 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: f Frequency: Hotel/Motel Business License? K Yes ❑ No 5 7-3r Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other Rooms inspected: IItjZ I(?.- Zs'. Z < "S 2. Comments: ` ` 1. '11�:V 1_'1 I 61&vvi L'A- row ta� W-si-joa4ft II violations in rooms not in ected must alsb be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received B Title: Environmen Hea pecialist: Phone: Z 01 _ b Page 1 of EHD 24-01 4-30-12 HOTEUMOTEL OR