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Complaint Investigation Form <br />COMPLAINT ID: C00046375 Site Location: 1120 E HAMMER LN <br />Received by: EE0000025 SEDRA <br />Assigned To: EE0000753 NG <br />Received Date: 3/25/1991 <br />Assigned Date: 4/18/2018 <br />Report #: 5104 <br />Account ID: : <br />Print Date: 4/18/2018 1 1:38:56AM <br />Program/Element Code:1600 - FOOD PROGRAM <br /> <br /> <br /> <br />VE11 <br />ure of complaint: <br />THIS COMPLAINT WAS FOUND IN FILE CABINET AND ALLEGES "24 YEAR OLD COMPLAINANT ATE GREEN LUNCH MEAT ON MARCH 23, <br />1991, PURCHASED FROM STORE ON MARCH 21, 1991. AT 2:00 PM UPSET STOMACH, MILD CASE OF FOOD POISONING. MR SANDS SAID <br />"PLEASE DO THE FOLLOW UP ON THIS CASE, THANK YOU." COMPLAINANT HAS 6 PACKAGES OF "SMOKE AROMA" GLENCOURT OF <br />WALNUT CREEK ZIP 94598-3592." ORIGINAL COMPLAINT NUMBER 91-0376 DATED 3/25/1991 (GIVING IT AN ENVISION COMPLAINT NUMBER <br />TO HAVE IN DATABASE FOR FUTURE REFERENCE). <br />Complaint Mode: P Complaint Mode Codes <br />A -Agency Referral B-Bd of Supervisors / City Council C -Counter F -Fax <br />E -Code Enforcement M -Mail / Correspondence O -Other EH Unit P -Phone <br />[-Internet / Email S -Sheriffs Office <br />PROPERTY INFORMATION <br />PROPERTY OWNER INFORMATION <br />Property Name: MR SANDS POISON CONTROL <br />Responsible Party or Property Owner <br />Site Location 1120 E HAMMER <br />RP/DBA PAK N SAVE MARKET <br />STOCKTON, CA 95210 <br />RP Address <br />Cross Street KATHLLEEN <br />Billing Address <br />Home Phone <br />Phone <br />Work Phone <br />District 002 - MILLER, KATHERINE <br />Location Code 01- STOCKTON <br />APN 09403043 <br />Date Abated 'I -) V_ - - <br />Inspector #`) <br />(C <br />— — — — — — — — — <br />— — <br />Send Referral to <br />Referral Letter Sent by <br />Referral Address <br />Date: <br />Complaint Status Code: i. C <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 />B9,- 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 amt Reviewed by: Datel� c� pate y: �� �y ate " <br />5104, rpt <br />