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r <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00047654 Site Location: 2180 MARIPOSA RD AccountlD.• AR0002852 <br /> Receivedby: EE0001788 CASTANEDA Received Date: 10/23/2018 Print Date: 10/23/2018 4:15:42PM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 10/23/2018 <br /> Program0ement Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT PURCHASED DUNKIN DONUTS ICED COFFEE ON 10/14/18 DRINK TASTED FUNNY,COMPLAINANT THREW UP AND NOTICED <br /> DRINK HAS EXPIRED SELL BY DATE OF JULY 18,2018-FA0808126-207. COMPLAINANT CONTACTED FACILITY AND THERE WERE NOT <br /> HELPFUL/CONCERNED ABOUT PUBLIC SAFETY. <br /> Complaint Mode: I Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet I Email S-Sheriffs Office <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0003278-Kmart#3174 Owner: OW0002315-Kmart Corporation <br /> Site Location 2180 E Mariposa Rd RP/DBA <br /> Stockton,CA 95205 RP Address <br /> <br /> <br /> <br /> <br /> - <br /> District 001-VILLAPUDUA,MIGUEL Location Code 01-STOCKTON <br /> APN 17306030 Or-PAXIA <br /> Date Abated 1 zz; /(oInspector ID#: d <br /> Send Referral to ` vReferral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 0 Office Response Only 52-LEAD Abatement Reqired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> t <br /> omplaint Reviewedy:- Z ate Date <br /> 5104.rpt <br />