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Complaint Investigation Form <br />COMPLAINT ID: C00046808 Site Location: 1110 W KETTLEMAN LN Account ID: : <br />Received by: <br />EE0000025 SEDRA <br />Assigned To: <br />EE0000753 NG <br />Program/Element CodeA600 <br />- FOOD PROGRAM <br />Complainant: <br />: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Fre of complaint: <br />)N 8/26/1991 AT 8:30 PM, 4 PEOPLE ATE A COMBINATION PIZZA AND SALAD WITH RANCH DRESSING. ALL 4 PEOPLE BECAME ILL THIS <br />IORNING (8/27/91) WITH SYMPTOMS OF DIARRHEA AND STOMACH CRAMPS. NO VOMITING. ORIGINAL COMPLAINT NUMBER 91-1464 <br />)ATED 8/27/91. <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-Intemet / Email S -Sheriffs Office <br />PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br />Property Name: PIZZA WORKS <br />Site Location 11 10 W KETTLEMAN <br />LODI, CA 95240 <br />Cross Street HAM <br />Phone <br />Responsible Party or Property Owner <br />RP/DBA PIZZA WORKS <br />RP Address <br />Billing Address <br />Home Phone <br />Work Phone <br />District 004 - WINN, CHARLES Location Code 02 - LODI <br />APN 06097013 <br />Date Abated q - � V Inspector ID #: C <br />�' / D ice` -1 <br />Send Referral to Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: CC,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 />&9! 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: ate. pate by: _ Date: <br />5104.rpt <br />