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Complaint Investigation Form Report# 5104 <br /> COMPLAINT ID: C00037871 Site Location: 520 CAROLYN WESTON BLVD STE f Account/D: AR0023586 <br /> Receivedby: EE0000467 CARRUESCO Received Date 4/18/2014 Print Date: 4/18/2014 2:06:41 PM <br /> Assigned To: EE0005366 MEDINA Assigned Date: 4/18/2014 <br /> Program/Element Code.1600-FOOD PROGRAM <br /> Complainant: :DAMIAN Home Phone : 909-269-2758 <br /> Address Work Phone <br /> Mail Address <br /> Nature of complaint: <br /> COCKROACH FOUND IN SALAD AND BUGS IN THE FOOD. <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-Internet/Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0013954-BETTO'S TAQUERIA&BIRRIERIA Owner: OW0006647-HERNANDEZ,JUAN 1 BERMUDEZ <br /> Site Location 520 CAROLYN WESTON BLVD STE A RP/DBA : <br /> STOCKTON,CA 95206 RP Address 168 SEVENTH ST <br /> Cross Street CAROLYN WESTON STOCKTON,CA 95206 <br /> Mailing Address: 520 CAROLYN WESTON BLVD STE A Billing Address 168 SEVENTH ST <br /> STOCKTON,CA 95206 STOCKTON,CA 95206 <br /> Home Phone 209-684-6912 EXT: CELL <br /> Phone :209-684-6912 Work Phone <br /> District 001-VILLAPUDUA Location Code <br /> APN 16422011 C p <br /> Date Abated y// Inspector ID#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:04�" <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE # <br /> 01- IELD 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 /> 65-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> O6- HD 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 /> 5104 rot <br />