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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT " 1868 East Hazelton Avenue, Stockton, CA 95202-6232 t" Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility:' Inspection Date: Ai � Address: S�O N. �� w ria ��L7 PE Q PR Owner/Operator: 7 Phone: Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: Q # 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): ❑ � 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- E) 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. ❑ 6 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. r� 1 Other Substandard or Unsafe Conditions: Electrical,structural,or plumbing hazards; Lack F1 10. r / 'C 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: Frequency: Hotel/Motel Business License? Wes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: D 6 05- Z/ Z 1-2— / n b, 4 Comments: © ,. Z. All violations in rooms not inspected must also be corrected. All re-insgoctions by the Environmental Health Department will be billed at the current hourly rate. Received By: Title: Environmentd 54ralth Specialist: Phone: Page 1 of EHD 24-01 4-30-12 �, _ HOTELIMOTEL OR