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> Complaint Investigation Form r n Report#:5104 COMPLAINT ID: 000029079 Site Location: 520 CAROLYN WESTON BLVD STE Account ID: AR0023586 Received by: EE0007541 FIELD Received Date: 9/12/2008 Print Date: 9/12/2008 12:27:47PM Assigned To: EE0001699 YOAKUM Assigned Date: 9/12/2008 rt Proram/Element Code:1600-FOOD PROGRAM Complainant: : ; Nature of com taint: BETWEEN•4016ON'0108, (C)& FAMILY ATE AT FACILITY. (C)ATE A PORK QUESADILLA WITH SOUR CREAM AND GUACAMOLE.((C)'S WIFE SAID GUACAMOLE TASTED FUNNY).ABOUT 2 112 HRS LATER,(C)BECAME ILL WITH SYMPTOMS OF SWEATING,BODY ACHES, STOMACH'A'CHE,VOMITING,&DIARRHEA. (DIARRHEA LASTED ALL NIGHT,&VOMITING CONTINUED THROUGH 9/10108). ON 9110/08,(C) WENT TO SAN JOAQUIN GENERAL EMERGENCY ROOM. BLOOD TESTS WERE TAKEN,AND(C)WAS TOLD HE HAD A BACTERIAL VIRUS. HE WAS GIVEN AN IV FOR VOMITING AND VICODIN FOR PAIN. (C)WAS STILL NOT FEELING WELL TODAY,9/12108. "*(C)REQUESTS A CALL BACK AFTER INSPECTION, Complaint Mode: P Complaint Mode Codes A Agency Referral B-Bd of Supervisors/City Council C-Counter E-Code Enforcement M-Mail 1 Correspondence 0-Other EH Unit P-Phone ------ - --------------------- FACILITY INFORMATION OWNER INFORMATION Facility:FA0013954-JALAPENQ'S T'AQUERIA Owner: OW0011041 -CERVANTES,REYES Site Location 520 CAROLYN WESTON BLVD STE A RP/DBA STOCKTON,CA 95206 RP Address 2735 NEMAHA WAY Cross Street CAROLYN WESTON STOCKTON,CA 95206 Mailing Address: 520 CAROLYN WESTON BLVD STE##A Billing Address 2735 NEMAHA WAY STOCKTON,CA 95206 STOCKTON,CA 95206 Home Phone :209-942-4147 Phone :209-234-2585 Work Phone :209-234-2585 District 001 -GUTIERREZ,STEVE Location Code 01-STOCKTON APN 16422011 Date Abated ?-�6 � Inspector: '1,yQgKN,z,? Send Referral to Referral Letter Sent by Referral Address Date: I Complaint Status Coder Circle appropriate Status Code 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE 02-OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# 03-NAI SENT 16-LETTER SENT TO TENANT 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE - 07-REFERRED TO OTHER AGENCY 20--ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed i No Major Violations 09-FOODBORNE ILLNESS (�)FOODBORNE ILLNESS-Major Violations Identified 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint Complaint History 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint Attached But Not 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) Scamed 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED2 ( ) / rpt