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PQ• �. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT y `A 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd ORt'` HOTEL/MOTEL OFFICIAL INSPECTION REPORT Name of Facility: `n y� Inspection Date: Address: SAID W .�A ARM'�/ 1�1 -6 PE:e2 11 D6 PR#: 050 7.�1 C) Owner/Operator: o I( nt4i6 1/1�L0 Phonnee':T D 1 Annual inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-inspection # Units in Facility: 104 # Units Inspected: (5 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- 3 P iS cfn- X 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. ❑ 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 Comgany Name: Frequency: MN LM�4 Hotel/Motel Business License? bYes INo Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑Other Rooms inspected:I 0. 1 2it5 20 Q 2 Comments: FireQ5hinoU[SPG9 CW" o All violations in rooms not inspected must glso be corrected. re—;Inspections b e Environmental Health Department will be billed at the current hourix rate. Received By: — Title: Go& Environ ntal ealth Specialist: rr�1� Phone:b C. C!V li O., Cv. (� Page 1 of EHD24-01 4-30-12 I fV HOTEUMOTELOIR