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r <br />Complaint Investigation Form Report#:5104 <br />COMPLAINT ID: C00046184 Site Location: 775 W CLOVER RD <br />Received by: EE0000040 JIMENEZ <br />Assigned To: EE0000753 NG <br />Received Date: 6/12/1991 <br />Assigned Date: 4/4/2018 <br />Program/Element Code:1600 - FOOD PROGRAM <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />ure of complaint: <br />THIS COMPLAINT WAS FOUND IN FILING CABINET AND ALLEGES "ON 6/11/2018 BETWEEN 6-6:30 PM, 4 PEOPLE ATE PEPPERONI PIZZA, <br />SALAD AND PEPSI -FAMILY BECAME ILL AT 11:30 PM - (21 YEARS OLD AND 9 MONTHS PREGNANT) HAD VOMITING & BURNING <br />STOMACH - (26 YEARS OLD) HAD DIARRHEA& VOMITING, BODY ACHED ALLOVER - (9 MONTHS) ATE CRUST SAUCE, NO <br />MEAT & SALAD , HE HAD DIARRHEA- (19 MONTHS) ATE EVERYTHING- HE HAD VOMITING AND DIARRHEA. ORIGINAL CO #910876 <br />DATED 06/12/1991 (GIVING ITAN ENVISION COMPLAINT # TO HAVE IN DATABASE FOR FUTURE REFERENCE.) <br />Complaint Mode: P Complaint Mode Codes A -Agency Referral <br />E -Code Enforcement <br />I -Internet / Email <br />PROPERTY INFORMATION <br />Property Name: <br />Site Location 775 W CLOVER <br />TRACY, CA 95376 <br />Cross Street <br />Phone <br />District 005 - ELLIOTT, BOB <br />APN 21418016 <br />B-Bd of Supervisors / City Council C -Counter F -Fax <br />M -Mail /Correspondence O -Other EH Unit P -Phone <br />S -Sheriff's Office <br />PROPERTY OWNER INFORMATION <br />Responsible Party or Property Owner: OPULENCE RIVER LLC <br />RP/DBA CHUCK E CHEESE RESTAURANT <br />RPAddress 775 W CLOVER RD <br />TRACY, CA 95376 <br />Billing Address 775 W CLOVER RD <br />Home Phone <br />Work Phone �,- <br />Location Code 03 - TRACY <br />Date Abated 1 �� J Inspector ID #: G <br />Send Referral to ` Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: CA <br />Circle appropriate Status Code <br />01 - Field Response -Violations Cited and Corrected <br />02 - Office Response Only <br />06 - Violations Cited - see Linked PROGRAM FACILITY FILE <br />07 - Refferred to Other Agency <br />08 - Unable to Verify Alleged Complaint <br />10 - POSTED SUBSTANDARD/UNSECURED - See Housing File <br />11 - Multiple Complaints - SEE ACTIVE CASE # <br />12 - DA Referred Complaint -See Program Enforcement Action Form <br />15 - ACTIVE HOUSING CASE - NEW COMPLAINT see ACTIVE CASE # <br />28 - Alleged FBI - No Major Violations Identified <br />29 -Alleged FBI - Major Violations Identified <br />50 - LEAD Assessment Performed -No Abatement Required <br />52 - LEAD Abatement Reqired-See Program Record File <br />97 - Disaster Planning and Response <br />99 UNSPECIFIED -Old Complaint -No Original Found <br />MN - EHD Monitoring Status <br />PD - Permit Issued -Pending Well Installation <br />RS - Resolved - New Well Installed <br />S1 -Tank pumped <br />S2 - Hooked up to public sewer <br />S3 - Septic system repaired <br />omp aint Reviewedy: at — pate y: at GIA <br />/ <br />5104.rpt <br />