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�P_q. SAN JOAQUIN COUNTY '� c ENVIRONMENTAL HEALTH DEPARTMEi. 1868 East Hazelton Avenue, Stockton, CA 95202-6232 Telephone: 209 468-3420 Fax: (209) 464-0138 Web:wv✓w.sigov.org/ehd HOTEL/MOTEL OFFICIAL INSPECTION REPORT , Name of Facility: / Inspection Date: l—�o.?u Lc 11 ems' - --- - - PE' PR# Address: , c' Sf 4,L-C Phone: Owner/Operator: _ Tic�i.^t Sc�,r-7�" - -- Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection #Units in Facility: V_ #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- 1 11h°k functioning sink/toileUbath' Lack of hot water. Floors: Not clean,properly covered or in S/�`�ri lis ❑ 2- 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. Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, ❑ 3. 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). El 5 Bedding: Matlress/linens infested with lice, bedbugs,or other insects; Not free from filth or foul matter; Unsafe; Linens not changed weekly or before new guest, F] 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate j close fitting covers;Garbage receptacles unclean or in disrepair.74 1 ❑ Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other publicly shared spaces, _ ❑ s. 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? _�j Yes ❑ No Company Name: Frequency: Hotel/Motel Business License? &es ❑ No Multi-Jurisdictional Violations to be Referred to: ❑City Building/Code Enforcement/Fire❑County Code Enforcement/Fire❑ Other Rooms inspected: l 2 0 Z O :2-0 /7 ';7 Comments: i/� C}chr •,; r i ' .L t53I� N"�'"� .rY��.r.�.--,es-�C blo•-..-..t �r C' .t All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health De artmentwill be billed atthe current hourly rate. Received By Title: Environmental Health Specialist: Phone: _ 3 Page 1 of EHD 24 01, 4-30-12 HOTEL/MOTEL OIR