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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C0004130 m Site Location: 3318 BROOKSIDE RD Account <br /> Received by: EE0005366 MEDINA Received Date: 4/7/2016 Pant Date: 4/7/20I611:34:57AM <br /> Assigned To: EE0003351 FLOHRSCHUTZ Assigned Date: 4/7/2016 <br /> Prooram/Element Code 1600-FOOD PROGRAM <br /> Complainant: :JUDY BEASLEY-ON CALL PUBLIC HEALTH NURSE Home Phone <br /> Address : Work Phone <br /> -Mail Atldress <br /> Nature ofcomplaint: <br /> PUBLIC HEALTH CALLED TO REPORT OUTBREAK OF GASTROINTESTINAL SYMPTOMS WITH DIARRHEA,VOMITING AND NAUSEA.ONSET <br /> OF SYMPTOMS 4/5/2016.ON 4/612016,4 RESIDENTS AND 1 STAFF MEMBER REPORTED SYMPTOMS.ON 4/7/2016,5 RESIDENTS REPORTED <br /> WITH SYMPTOMS,THE FACILITY HAS CEASED DINING OPERATIONS AS OF 4/6/2016 8:OOPM.2 PUBLIC HEALTH NURSING STAFF HAVE <br /> BEEN ASSIGNED TO CONDUCT INVESTIGATION.JONATHAN 209-468-3883.SINAL SINGH 209-468-9483. PUBLIC HEALTH REQUESTS <br /> ENVIRONMENTAL HEALTH DEPARTMENT STAFF TO ASSIST IN INVESTIGATION. <br /> Complaint Mode: A 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-Internet/Email S-Sherill's Office <br /> ------------------------------------------------- <br /> PROPERTY <br /> _-- —__-- -----_—_ ---------- ------ <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name:ATRIA RAYSIDE LANDING Responsible Party or Property Owner <br /> Site Location 3318 BROOKSIDE RPiDBA OAKMONT OF STOCKTON LLC ETAL <br /> STOCKTON,CA 95219 RP Address 21001 N TATUM BLVD 41630-630 <br /> Cross Street MARCH PHOENIX,AZ 85050 <br /> Billing Address 21001 N TATUM BLVD 41630-630 <br /> Home Phone <br /> Phone : Work Phone <br /> District 003-BESTOLARIDES,STEVE Location Code 01-STOCKTON <br /> APN 11806012 11 <br /> Date Abated `—, — I L Inspector ID#: 'F L h rx h W+ 2 <br /> ------------------------------------------------- <br /> Send <br /> --- ----------- — ---------------------------Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: d0 <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-Field Response-Violations Cited and Corrected 28 Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Regired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Relferred to Other Agency <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompaint Reviewed by, C ate: Updated y: Date,*, iD <br /> 51N Fpt L7 <br />