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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00039723 Site Location: 3201 W BENJAMIN HOLT DR STE 13, AccountlD: AR0039272 <br /> Received by: EE0000025 SEDRA Received Date: 5/22/2015 Print Date: 5/22/2015 1:56:11PM <br /> Assigned To EE0006213 PEDRAZA Assigned Date: 5/22/2015 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant ERICA MENDOZA Home Phone 209-817-3451 <br /> Address Work Phone :209-351-3077 <br /> -Mail Address <br /> Nature of complaint: <br /> COMPLAINANT WAS THERE ON 5/22/2015 AT ABOUT 11:30 AM.COMPLAINANT ALLEGES THAT THE STAFF WERE BAREFOOT,THERE WERE <br /> DIRTY DISHES,DIRTY BLENDERS LEFT OPEN ON COUNTERS THEN USED WITHOUT BEING CLEANED. SAME SCOOPS BEING USED FOR <br /> ALL POWDERS INCLUDING THE PEANUT BUTTER. <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 /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0021655-HOOKED HEALTH&WELLNESS CLUB Owner: OW0017817-WRIGHT,MYA <br /> Site Location 3201 W BENJAMIN HOLT DR STE 133 RP/DBA HOOKED HEALTH&WELLNESS CLUB <br /> STOCKTON,CA 95219 RP Address 1 103 DARTMOOR CIR <br /> Cross Street HERNDON LODI,CA 95240 <br /> Mailing Address: 3201 W BENJAMIN HOLT DR STE 133 Billing Address 1103 DARTMOOR CIR <br /> STOCKTON,CA 95219 LODI,CA 95240 <br /> Home Phone :209-200-2990 <br /> Phone :209-200-2990 Work Phone <br /> District 002-MILLER,KATHERINE Location Code 0I-STOCKTON <br /> APN 10017009 <br /> Date Abated 1 c Inspector/D#: <br /> l <br /> --------- --- ---- ------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date. <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Regired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omp aint Reviewed by: Date -IFpdate by ate: <br /> `104 rpt <br />