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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000036296 Site Location: 1555 N CHRISMAN RD AccountlD: AR0026940 <br /> Received by: EE0006213 PEDRAZ4 Received Date: 4122/2013 Print Date: 4/22/2013 9:21:47AM <br /> Assigned To: EE0001420 NISSIM Assigned Date: 4/22/2013 <br /> Program/Element Code: i00-FOOD PROGRAM <br /> Complainant: NERARDO PEREZ Nome Phone 760-9874461 <br /> Address Work Phone <br /> -Malt Address <br /> Nature of com laint: <br /> ON 4101113 @ 10:15 AM(C)PURCHASED AND CONS LIME DA FRIED PORK CHOP WITH BEANS AND RICE.AT ABOUT 11 AM(C)GOT <br /> NAUSEATED @ 3:45(C)WENT RESTROOM @ ABOUT 5 PM(C)WENT TO THE HOSPITAL.THE DOCTOR DIAGNOSED(C WITH FOOD <br /> POISONING.(C)PURCHASED FOOD FROM ERIC CATERING TRUCK AT 1555 N CHRISMAN. LIC PLATE#6M96419 P _ <br /> Complaint Mode: p Complaint Mode Codes A-Agency Referral B-8d of Supervisors t City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> (-Internet 1 Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:F'A0015601-ERICK CATERING 96M96419 Owner: OW0012548-BOLANOS,ERICK <br /> Site Location 2440 S AIRPORT WAY RP/DBA ERICK CATERING <br /> STOCKTON,CA 95206-3342 RPAddress 663 WILLIAM MOSS BLVD <br /> Cross Street STOCKTON,CA 95206 <br /> Mailing Address: 663 WILLIAM MOSS BLVD Billing Address 663 WILLIAM MOSS BLVD <br /> STOCKTON,CA 95206 STOCKTON,CA 95206 <br /> Home Phone :209-922-7677 <br /> Phare :209-466-9000 EXT: COMMISSARY Work Phone <br /> District 005-ORNELLAS,LEROY Location Code 03-TRACY <br /> APN <br /> Date Abated _ 1 Inspector ID <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Codeo� <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 ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br /> 19-END 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 SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104rpt <br />