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COMPLAINT ID: C00047616 <br />Complaint Investigation Form Report #: 5104 <br />Site Location: 4725 QUAIL LAKES DR <br />Received by: EE0000467 CARRUESCO <br />Assigned To: EE0006213 PEDRAZA <br />Received Date: 10/19/2018 <br />Assigned Date: 10/19/2018 <br />Program/Element CodeA600 - FOOD PROGRAM <br />Complainant: : <br /> <br /> <br /> <br /> <br /> <br /> <br />SEPTEMBER 26, CUSTO E PURCHASED 4-5 OYSTERS THAT WERE ON ICE. CONSUMED OYSTERS AND BECAME SICK. WAS DIAGNOSED <br />WITH VIBRIO 8A 10 l -J k9 <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 OWNER INFORMATION <br />Facility: FA0002597 - S -Mart 09 <br />Site Location 4725 QUAIL LAKES DR <br />Stockton, CA 95207 <br />Cross Street QUAIL LAKES <br />Mailing Address: 1800 Standiford Ave. <br />Modesto, CA 95350 <br />Phone : 209-952-0525 EXT: <br />Owner: OW0000369 - Save Mart Supermarkets <br />RP/DBA <br />: <br />RP Address <br />1800 STANDIFORD AVE <br />MODESTO, CA 95350 <br />Billing Address <br />1800 Standiford Ave <br />Modesto, CA 95350 <br />Home Phone <br />:209-574-6299 EXT: 111 <br />Work Phone <br />:209-577-1600 EXT: <br />District 002 - MILLER, KATHERINE Location Code 01- STOCKTON <br />APN 112-210-120-000 <br />Date AbatedV/"J I Inspector ID #: � 7. <br />Send Referral to Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: 2 <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 />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 />ompaintReviewed by: Date: Updated by: Date: <br />5104.rpt <br />