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Complaint Investigation Form <br />COMPLAINT ID: C00046667 Site Location: 5308 PACIFIC AVE <br />Received by: EE0000040 JIMENEZ <br />Assigned To: EE0000753 NG <br />Program/Element Code: 1600 - FOOD PROGRAM <br />Complainant: : <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />THIS COMPLAINT WAS FOUND IN FILING CABINET AND ALLEGES "ON 8/2/1991 -ATE TURKEY SANDWICH AT 12:00 PM -AT 7:00 PM, BEGAN <br />-iAVING STOMACH CRAMPS - WENT TO DOCTOR ON 8/6/1991 AFTER BEING ILL FOR FOUR DAYS - DOCTOR SUSPECTED POSSIBLE <br />SALMONELLA." ORIGINAL CO # 911322 DATED 8/9/1991 (GIVING ITAN ENVISION COMPLAINT # TO HAVE IN DATABASE FOR FUTURE <br />REFERENCE.) <br />Complaint Mode: P Complaint Mode Codes 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 />I -Internet / Email S -Sheriffs Office <br />PROPERTY INFORMATION <br />Property Name: <br />Site Location 5308 PACIFIC <br />STOCKTON, CA 95207 <br />Cross Street <br />Phone : <br />District 002 - MILLER, KATHERINE <br />APN 10224021 <br />PROPERTY OWNER INFORMATION <br />Responsible Party or Property Owner: LA BOULANGERIE, SHERWOOD MALL <br />RP/DBA LA BOULANGERIE, SHERWOOD MALL <br />RPAddress 5308 PACIFIC AVE <br />STOCKTON, CA 95207 <br />Billing Address 5308 PACIFICAVE <br />Home Phone : 209-472-0995 <br />Work Phone > <br />Location Code 01 - STOCKTON <br />Date Abated [-� i 7 Inspector ID #: /\�� % <br />Send Referral to Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: j{ <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 Regired-See Program Record File <br />97 - Disaster Planning and Response <br />:99 UNSPECIFIED -Old Complaint -No Original Found <br />N - 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 Reviewed by: ate: pate y:Date:- <br />5104. rpt <br />�/ ate:5104.rpt <br />