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AWComplaint Investigation Form Report 5104 <br /> COMPLAI ID: C00036176 Site Location: 3201 W BENJAMIN HOLT OR AccountlD: AR0001793 <br /> Received by: EE0004636 BACKUS Received Date: 3/25/2013 Print Date: 3/25/2013 9:50:43AM <br /> Assigned To: EE0004636 BACKUS Assigned Date: 3125/2013 <br /> Program/Element ode:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> KITCHEN FIRE OCCURRED SATURDAY MORNING 3123113.THE ANSEL SYSTEM WAS ACTIVATED TO EXTINGUISH THE FIRE <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> l-InternetI Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facitity:FA0001793-CASA FLORES Owner: OW0012778-CRUCES FLORES LLC <br /> Site Location 3201 W BENJAMIN HOLT DR STE 155 RPIDBA CASA FLORES <br /> STOCKTON,CA 95219 RP Address 9028 BRIDALVEIL CIR <br /> Cross Street STOCKTON,CA 95212 <br /> Mailing Address: 3201 W BENJAMIN HOLT DR STE#155 Billing Address 9028 BRIDALVEIL CIR <br /> STOCKTON,CA 95219 STOCKTON,CA 95212 <br /> Home Phone :209-993-5326 <br /> Phone :209-451-1116 Work Phone :209451-1116 <br /> District 002-RUHSTALLER,LARRY Location Code 01-STOCKTON <br /> APN 10017009 <br /> Date Abated `j Inspector ID#.- <br /> Sand <br /> .Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01 FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record Fite <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />