Laserfiche WebLink
Complaint Investigation Form <br /> Report#:5104 <br /> COMPLAINT ID: C00037109 Site Location: 2808 COUNTRY CLUB BLVD Account ID: AR0021257 <br /> Received by: EE0002670 NAIDU Received Date: 10/10/2013 <br /> Assigned To: EE0003361 FLOHRSCHUTZ 1 Print Date: 10/1112013 1030:12AM <br /> Assigned Date: 10/10/2013 <br /> Proaram/Element Code 1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> , <br /> Nature of cow taint: j <br /> SODA MACHINE IN THE DELI DEPARTMENT HAD PINK SLIME COMING OUT OF IT <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Cade Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone <br /> I-Internet 1 Email S-Sheriffs Office <br /> — <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 RPAddress 5918 STONERIDGE MALL RD <br /> I Cross Street PLEASANTON,CA 94588-3229 <br /> 4 Mailing Address: PO BOX 29096 Billing Address 5918 STONERIDGE MALL RD <br /> PHOENIX,AZ 85038-9096 PLEASANTON,CA 94588-3229 <br /> Nome Phone :925-467-3845 <br /> i Phone :209 461-5555 Work Phone :623-869-6100 <br /> District 003-BESTOLARIDES Location Code 01-STOCKTON <br /> APN 12118043 <br /> Date Abated t,�� (.{-i3 Inspector 1D#: l0 <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: O <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 $0-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br /> O6 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 /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />