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Complaint Investigation Form Report#:5104 <br /> i <br /> COMPLAINT ID: 00029554 Site Location: 39 W CHARTER WAY Account ID: AR0004601 <br /> Received by: EE0000321 OLIVEIRA Received Date: 1 211 7/2 00 8 Print Date:12/17/2008 4:12:15PM <br /> Assigned To: EE0003474 VEGA Assigned Date: 12/17/2008 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant. :EDWARD ROBINSON Nome Phone : 209-983-8201 <br /> Address Work Phone <br /> Nature of complaint. <br /> ON 12116108,(C)PURCHASED FARMER JOHN OLD-FASHIONED MAPLE PORK LINKS(8 OZ. PACKAGE)FROM REFRIGERATED DISPLAY <br /> CASE. THE USE OR FREEZE DATE WAS 1211108. (C)ATE ONE LINK ON 12116108,AND TODAY WAS FEELING ABDOMINAL PAIN. --(C) <br /> REQUESTS A CALL BACK FROM INSPECTOR AFTER INSPECTION. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bel of Supervisors 1 City Council C-Counter F-Fax <br /> --—`E-Code Enforcement M-Mail!Correspondence O Other EH Unit P-Phone <br /> ———— ———— ——— <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002381-SUPERSAVE MARKET Owner: OW0001829-CHEN,WILLIAM;ZI MING WU ETC <br /> Site Location 39 W CHARTER WAY RP/DBA SUPERSAVE MARKET <br /> STOCKTON,CA 95206 RPAddress 39 W CHARTER WAY <br /> Cross Street CHARTER STOCKTON,CA 95206 <br /> Mailing Address: 39 W CHARTER WAY Billing Address 39 W CHARTER WAY <br /> STOCKTON,CA 95206 STOCKTON,CA 95206 <br /> Home Phone :209-464-7610 <br /> t Phone :209464-8295 Work Phone :209464-7610 <br /> District 001 -GUTIERRE4 STEVE Location Code 01-STOCKTON <br /> APN 14716038 <br /> — Date Abated �� - j/- S7 Inspector., —3 <br /> Referral Letter Sent by <br /> Send Referral to — — `— <br /> Reterra! — —Address Date: <br /> I <br /> I <br /> Complaint Status Code: yrj/ <br /> M Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> 02-OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT 16-LETTER SENT TO TENANT <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> I ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> I EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed 1 No Major Violations <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations identified <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint Complaint Hi stOT-N <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint Attached But N of <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) Scanned <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 51 .rpt <br />