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Complaint Investigation Form <br />COMPLAINT ID: C00046699 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 "AT 6:00 PM ON 12/9/1991 ATE AT THE MEXICAN FOOD STAND LOCATED <br />BETWEEN THE PIZZAAND CHINESE FOOD STANDS - ATE A CHILE RELLENO AND RICE - A HALF HOUR LATER HAD DIARRHEAAND TWO <br />HOURS LATER IT INCREASED - NO PHYSICIAN SEEN - STILL FEELS ILL." ORIGINAL CO # 912187 DATED 12/10/1991 (GIVING IT AN <br />ENVISION COMPLAINT # TO HAVE IN DATABASE FOR FUTURE REFERENCE.) <br />Complaint Mode: P Complaint Mode Codes A -Agency Referral B-Bd of Supervisors / City Council <br />E -Code Enforcement M -Mail / Correspondence O -Other EH Unit <br />I -Internet / Email S -Sheriffs Office <br />-------------------------------------------------------------------------------------------------------------------------------------------------------- <br />PROPERTY INFORMATION PROPERTY OWNER 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 10224019 <br />C -Counter F -Fax <br />P -Phone <br />Responsible Party or Property Owner: SHERWOOD MALL EATERY <br />RP/DBA SHERWOOD MALL EATERY <br />RPAddress 5308 PACIFIC AVE <br />STOCKTON, CA 95207 <br />Billing Address 5308PACIFICAVE <br />Home Phone <br />Work Phone <br />Location Code 01 - STOCKTON <br />Date Abated WP / U Inspector ID #: L) 9 <br />Send Referral to / Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: <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 />_g*- UNSPECIFIED -Old Complaint -No Original Found <br />i <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 />ompaint Reviewed by: ate:-, p ate y at <br />5104.rpt <br />