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Complaint Investigation Form Report#: 5104 <br />COMPLAINT ID: C000475" Site Location: 1120 E HAMMER LN AccountlD. AR0001198 <br />Received by: EE0000014 MORENO Received Date: 10/3/2018 Print Date: 10/3/2018 11:12:21AM <br />Assigned To: EE0078788 FAHMY Assigned Date: 10/3/2018 <br />Program/Element Cpdej 600 - FOOD PROGRAM <br />Complainant • : <br /> <br /> <br />Nature of complaint: <br />ROACHES IN THE FREEZER OF THE 99 CENTS STORE. PLEASE SEND INSPECTOR. <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 OWNER INFORMATION <br />Facility: FA0001200 - 99 Cents Only Stores #177 <br />Site Location 1120 E Hammer Ln <br />Stockton, CA 95210 <br />Cross Street KATHLEEN <br />Mailing Address: 4000 Union Pacific Avenue <br />Commerce, CA 90023 <br />Phone :209-956-4992 EXT: <br />District 002 - MILLER, KATHERINE <br />APN 09403043 <br />Date Abated <br />---------------------------------------------------------------U------- <br />Send Referral to <br />Referral Address <br />Complaint Status Coder <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 />08nable 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 />Owner: OW0010964 - 99 Cents Only Stores <br />RP/DBA <br />RPAddress 4000 UNION PACIFIC AVE <br />COMMERCE, CA 90023 <br />Billing Address 4000 Union Pacific Avenue <br />Commerce, CA 90023 <br />Home Phone : 323-980-8145 <br />Work Phone <br />Location Code 01- STOCKTON <br />Inspector ID #: <br />------------------------------ <br />Referral Letter Sent by <br />Date: <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 />omplaint Reviewedy:l V ate: pate y: Date: V <br />5104.rpt <br />