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- Complaint Investigation Form Report#:5104 <br /> 4 <br /> COMPLAINT ID: CO 028965 Site Location: 2808 COUNTRY CLUB BLVD Account ID: AR0021257 <br /> Received by: EEO 07541 FIELD Received Date: 9/2/2008 Print Date: 9!2/2008 4:55:47PM <br /> Assigned To: EEO 03474 VEGA Assigned Date: 9/2/2008 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: ;TA YA URIARTE Nome Phone 209-298-3282 <br /> Address Work Phone <br /> Nature of complaint. <br /> AROUND 7 PM ON 911108,(C)PURCHASED REGULAR CHICKEN STRIPS. ONE OF THE EMPLOYEES HAD CUT THEIR FINGER AND BLOOD <br /> WAS ON THE OUTSIDE AND INSIDE OF BAG. WHEN (C)REALIZED THERE WAS BLOOD INSIDE BAG, SHE WAS/IS GREATLY CONCERNED <br /> THAT THE BLOOD MAY HAVE GOTTEN ONTO SOME OF THE CHICKEN STRIPS. THE EMPLOYEE SHOWED THE (C)WHERE SHE HAD CUT <br /> HER FINGER. (C)HAD A PANIC ATTACK AND HAD TO BE DRIVEN HOME. -(C)IS REQUESTED INSPECTOR CALL HER BEFORE <br />' INSPECTING FACILITY,AS SHE HAS QUESTIONS ABOUT WHETHER THE EMPLOYEE WAS CAUGHT ON CAMERA OF NOT WEARING <br /> GLOVES, <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail/Correspondence O.Other EH Unit P-Phone <br /> ----- - -------------- — ---------- <br /> — <br /> FACILITY INFORMATION OWNER INFORMATION — — <br /> Facility:FA0012734-SAFEWAY#1769 Owner: OW0009849-DAWES,ROBERT <br /> Site Location 2808 COUNTRY CLUB BLVD RP/DBA SAFEWAY STORE#1769 <br /> STOCKTON,CA 95204 RP Address 5918 STONERIDGE MALL RD <br /> Cross Street PLEASANTON,CA 94588-3229 <br /> Mailing Address: PO BOX 29096 Billing Address 5918 STONERIDGE MALL RD <br /> PHOENIX,AZ 85038-9096 PLEASANTON,CA 94588-3229 <br /> Home Phone :925467-3845 <br /> Phone :209461-5555 Work Phone :623-869-6100 <br /> District 003-MOW,VICTOR Location Code 01 -STOCKTON <br /> APH 12118043 <br /> IIF Date Abated �- �� aQ� Inspector., S"f <br /> -- ------------------- - ------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address <br /> Date: <br /> Complaint Status Coder <br /> 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 /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> OS 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 i 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 Soni-Confirmed Complaint <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-"l 5 Day Letter Sent-Alleged Complaint Complaint History <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) Attached But Not <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) Scanned <br /> 51 C»i.rpt <br />