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Complaint Investigation Form Report#:5104 <br /> COMPLAIN �C00035921Site Location: 714 N CENTRAL AVE Account tD. AR0002756 <br /> Received by: EE0009058 LOWE Received Date: 1/24/2013 Print Date: 1/24/2013 2:33:54PM <br /> Assigned To: EE0001420 NISSIM Assigned Date. 1/24/2013 <br /> Program'Element Code 1500-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> DOG SEEN IN FACILITY ON 2 DIFFERENT OCCASIONS <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-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0003188-GREAT PLATE BAR&GRILL,THE Owner: OW0002377-GALLEGOS,JACOBO <br /> Site Location 7t4 N CENTRAL.AVE RP/DBA GREAT PLATE BAR&GRll.l,(THF) <br /> TRACY,CA 95376 RP Address 261 BUTTE WAY <br /> Cross Street CENTRAL TRACY,CA 95376 <br /> Mailing Address: 714 N CI:NTRAL AVE Billing Address 261 BUTTE WAY <br /> TRACY,CA 95376 TRACY,CA 95376 <br /> Home Phone :773-494-6901 EXT: CELL <br /> Phone 209-833-6862 Work Phone <br /> 209-833-0862 <br /> District Location Code <br /> APN -) <br /> r <br /> Date Abated — 1. Inspector ID <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date. <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNE=SS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMLNT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record Fife <br /> 05-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 1 I-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104 rpt <br />