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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00015325 Site Location: 2120 COUNTRY CLUB BLVD Account ID: AR0001442 <br /> Received by: EE0000794 MATHEW Received Date: 12/20/2000 <br /> Assigned To: EE0009157 BARCELLOS Assigned Date: 12/21/00 <br /> Proaram/Element Code• 1624-RESTAURANT/BAR 21-50 SEATS <br /> <br /> <br /> Nature of complaint. <br /> ATE BBQ BEEF SANDWICH ON THE 15th OF DECEMBER ABOUT LUNCH TIME AND BECAME ILL ON 17th WITH HEADACHE, <br /> VOMITING,ABDOMINAL PAIN AND DIARRHEA.DOCTOR SEEN AT DR.McOMBERS OFFICE, DIAGNOSED ON 18th. <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council E-Code Enforcement <br /> M-Mail/Correspondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0001443-COUNTRY CLUB DRIVE IN Owner: OW0001125-COUNTRY CLUB DRIVE IN <br /> RP/DBA: COUNTRY CLUB DRIVE IN <br /> Site Location: 2120 COUNTRY CLUB BLVD <br /> STOCKTON,CA 95204 RP Address: 2120 COUNTRY CLUB <br /> STOCKTON,CA 95204 <br /> Mailing Address: 2120 COUNTRY CLUB <br /> STOCKTON,CA 95204 Billing Address:: 2120 COUNTRY CLUB <br /> STOCKTON,CA 95204 <br /> Phone: 1st: 209-464-2353 Phone: <br /> Wk: 209-464-2353 <br /> District 001 -GUTIERREZ,STEVE Location Code 99-UNINCORPORATED AREA <br /> APN <br /> Date Abated <br /> Inspector <br /> Send Referral to: <br /> Referral Address: <br /> Referral Letter Sent by: <br /> Date: p <br /> Complaint Status Code: D-t <br /> 01-Field Abated 10-Substandard Property-See HOUSING ABATEMENT 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 /> 05-Enforcement Action Initiated 50- Lead Hazard Evaluation Required(1) <br /> 06-EHD Permit Facility-See Linked Premise File 52- Lead Hazard Abatement in Progress(3) <br /> 07-Referred To Other Agency 53-Lead Hazard Visual Inspect Satisfactory(4) <br /> 0�-Invalid/Unable To Verify 51 - Lead Hazard Work Plan Subm Rted(2) <br /> Q�Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55- Lead Hazard Monitoring Schedule (6) <br /> 12-Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete (7) <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant W/Soil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> 61o4.rpt <br />