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oPs� !tr. SAN JOAQUIN COUNTY E rIRONMENTAL HEALTH DEPAR; ' ENT 186b zast Hazelton Avenue, Stockton , CA 9b�02-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.org/ehd .'.•�gt. FP•. HOTEUMOTEL OFFICIAL INSPECTION REPORT Name of Facility: + V ` MO . r Inspection Date: : t Address: 1 •Z / r PE:9 7 ,y�/ Owner/Operator: Phone: 179zZ7z Annual Ins ection ❑ 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): F] 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- ,.r.\ 5 VX4, LA 2 functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or ino� 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. Other Substandard or Unsafe Conditions: Electrical, structural, or plumbing hazards; Lack rl 10. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate^ t � protection from weather; Inadequate sewage or water facilities. Pest control Used? XYes ❑ No Company Name: 6 12, (,L Frequency: Hotel/Motel Business License? ❑ Yes ❑ No Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire ❑ County Code Enforcement/Fire ❑ Other Rooms inspected: 11 , { j 6 16 g ,2 Comments: All violations in rooms not inspected must also be corrected. All re-inspections by the Environmental Health Department will be billed at the current hourly rate. Received By: Environmental Health Specialist: L&tX ate+•— Phone: Z i 33 1 Page 1 of EHD 24-01 4-30-12 ./ HOTEL / MOTEL OR