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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00040855 Site Location: 2808 COUNTRY CLUB Account04AR0041583 <br /> I <br /> Received by: 110006213 PEDRAZA Received Date: 12130!2015 Print Date: 12/30/2015 8:47:42AM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 1213012015 <br /> Proaram/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of com laint: is <br /> COMPLAINANT ALLEGES THERE IS STANDING WATER IN THE BACK ROOM IN THE DELI FROM THE FLOOR DRAIN, ROTO ROOTER <br /> WORKING ON IT.THE DELI WILL CLOSE AND REMAIN CLOSED UNTIL REPAIRS ARE COMPLETED,NO PROBLEMS IN THE REST OF THE <br /> STORE. <br /> Complaint Mode: p Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Intemet 1 Email S-Sheriffs Office <br /> T <br /> PROPERTY INFORMATION OWNER INFORMATION 'i <br /> Facility:FA0022709-SAFEWAY STORE#1769 Owner: OW0000429-SAFEWAY.INC <br /> Site Location 2808 COUNTRY CLUB BLVD RP/DBA i <br /> STOCKTON,CA 95204 RP Address 5918 STONERIDGE MALL RD <br /> Cross Street PLEASANTON,CA 94588 <br /> Mailing Address: PO BOX 29096 MS 6516 Billing Address PO BOX 29096 MS 65 16 <br /> PHOENIX,AZ 85038 PHOENIX,AR 85038-9096 <br /> Home Phone ;925-467-3000 <br /> Phone :209461-5555 Work Phone � <br /> District 003-BESTOLARIDES,STEVE Location Code <br /> APN t ^ , <br /> Date Abated '� ?)D Inspector 1D#: (<Q P71rSU-`u 4 2- <br /> ------------------------------------------------ <br /> Send <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complain!Status Code: OW <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -FIELD ABATED 26-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response. <br /> 06 EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New W0 Installed <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form I <br /> omp aint Reviewed by: t (a ate: ed by: l ate: <br /> 5104.rpt K/ :� <br />