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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00045592 Site Location: 3201 W BENJAMIN HOLT DR Account ID: <br /> Receivedby: EE0000040 JIMENEZ Received Date: 8/22/1991 Print Date: 1/302018 1:40:10PM <br /> Assigned To: EE0000753 NG Assigned Date: 1/30/2018 <br /> ProgramrEtement Code:1600-FOOD PROGRAM <br /> Complainant: :STEVE BROCKETT Home Phone : 209-478-3336 <br /> Address Work Phone <br /> -Mall Address <br /> Nature ofcomplaint: <br /> ATE PEPPERONI&SAUSAGE PIZZA ON AUGUST 19, 1991 AT 5:00 PM.BEGAN TO HAVE SYMPTOMS, FEVER VOMITING AND CRAMPS THE <br /> NEXT DAY AT 6:00 AM. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Coda Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name:ROUND TABLE PIZZA Responsible Party or Property Owner <br /> Site Location 3201 W BENJAMIN HOLT RP/DBA ROUND TABLE PIZZA <br /> STOCKTON,CA 95219 RPAddress <br /> Cross Street <br /> Billing Address <br /> Home Phone <br /> Phone Work Phone <br /> District 002-MILLER,KATHERINE Location Code 01-STOCKTON <br /> APN 10017009 q <br /> Date Abated D •1 b• `� Inspector ID#: IL TP <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 0O <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> OB Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> Referred 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 /> ompaint Reviewed by. ate: l Updated y: a3 / <br /> �. <br /> 5104.rpt <br />