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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: a <br /> N- 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> P <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: L CO end c� �U Inspection Date: J1LOz <br /> Address: I Sy0 /T. V Ac�ra4o st. JtoGKtor PE:'ZlrUg PR#: <br /> Owner/Operator: -To,Y�k M <br /> 1 emit ZVN <br /> Phone: <br /> nnual Ins ction Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> # Units in Facility: G� #Units Inspected: Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> 1 garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- 'b Yo"4,% 1 i'}h,11'Fik t �- <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in 3�Q— FlaOr 1 two_ <br /> 2' good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water C.�'�"'PI K <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. <br /> rFEJ <br /> 3. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> working condition; Lack of adequate heat(Standard: 70°F at 3 feet from floor). <br /> Drinking Utensils&Ice Buckets: Not protected from contamination; Lack of or improper <br /> ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping (single-use). <br /> ❑ 5 Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> ❑ 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> 7.❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways, stairways,exits,or other <br /> publicly shared spaces. <br /> ❑ 8. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack ,moire <br /> 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate <br /> protection from weather; Inadequate sewage or water facilities. <br /> Pest control Used? 2ryes ❑ No Company Name: i,,, z e, " Frequency: '— W e <br /> Hotel/Motel Business License? KYes ❑ No / '�; / L <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: w/; U �I L �� f'�tCk- trw'^ <br /> Comments: <br /> - Fire Ck_,c,-K -ak <br /> lre,cvw n.e wt .4, l Uc-( 1�o o t) e r ot e lo 1A <br /> All violations in rooms not inspected must also be corrected. <br /> All re-inspections by the Environmental Health Department will be billed at the current hourly rate. <br /> Received By: j Title: ,rte ,��1 p �� <br /> ��.(t\A �-9— �e tM t ' ' 1 � v rl <br /> Environmental Health Specialist: rYh�CPhone: �0 9 (,/¢����j Page 1 of <br /> HOTEUMOTEL OR <br /> EHD 24-01 4-30-12 tk 53 L((.( lD o <br />