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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00047683 Site Location: 4450 E. WATERLOO RD Account ID: AR0023837 <br /> Received by: EE0009830 SAUERS Received Date: 10/30/2018 Print Date: 10/30/2018 1:28:53PM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 10/30/2018 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature ofcomplaint: <br /> FACILITY IS DIRTY.COMPLAINANT ALLEGES THE SODA MACHINE DOESN'T APPEAR TO BE CLEAN.MOLD AROUND SODA DISPENSER. <br /> KITCHEN HAD TRASH LEFT ON FLOOR. <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 0-Other EH Unit P-Phone <br /> I-Intemet I Email S-Sheriffs Office <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0014100-KFC/A&W#284 Owner: OW0011163-Froilan 284,Inc. <br /> Site Location 4450 E WATERLOO RD RP/DBA : <br /> STOCKTON,CA 95215--230 RP Address 8334 GERBER RD <br /> Cross Street SACRAMENTO,CA 95828 <br /> Mailing Address: 1555 Meadowview Road,Suite 150 Billing Address 1555 Meadowview Road,Suite 150 <br /> Sacramento,CA 95823 Sacramento,CA 95832 <br /> Home Phone :510-429-7925 <br /> Phone :209-931-8994 EXT: Work Phone :916-553-2267 EXT: <br /> District 002-MILLER,KATHERINE location Code <br /> APN <br /> Date Abated �&bV I`v Inspector ID#: V <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> IScle appropriate Status Code <br /> \Q.1)Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-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 /> omp aint Reviewed by:• .. I Date: pdate by: , at <br /> 5104.rp1 <br />