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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00041054 Site Location: 2808 COUNTRY CLUB BLVD Account 11): AR0041583 <br /> Received by: EE0000025 SEDRA Received Date: 2/10/2016 Print Date., 2/10/2016 12:48:15PM <br /> Assigned 7o: EE0003361 FLOHRSCHUTZ Assigned Date: 2/1012016 <br /> Progrem/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> ON 211 /2016 AT 12:26 PM THERE WAS A FIRE IN THE FREEZER IN THE BAKERY DEPT. FIRE UNITS ARE STILL ON SCENE. <br /> Complaint Mode: A 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 E 1-f Unit P-Phone <br /> I-Intemet 1 Emai$ S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY <br /> ------ -----T ---------- --------- ---------PROPERTY INFORMATION OWNER INFORMATION ., <br /> Facility:FA0022709-SAFEWAY STORE#1769 Owner: OW0000429-SAFEWAY INC <br /> Site Location 2808 COUNTRY CLUB BLVD RP/DBA <br /> STOCKTON,CA 95204 RP Address 5918 STONERIDGE MALL RD <br /> Cross Street HWY 5 PLEASANTON,CA 94588 <br /> Mailing Address: PO BOX 29096 MS 6516 Billing Address PO BOX 29096 MS 6516 <br /> PHOENIX,AZ 85038 PHOENIX,AR 85038-9096 <br /> Nome Phone :925-467-3000 <br /> Phone :209461-5555 Work Phone <br /> District 003-BESTOLARIDES,STEVE Location Code 01-STOCKTON <br /> APN 12118043 <br /> Date Abated (p Inspector ID#: <br /> ----------- ----------- <br /> Send <br /> ---------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: [r <br /> Complaint Status Code: <br /> Circle appropriate Status Code :> <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE#, <br /> 01-FIELD ABATED 28-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 Regired-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 SUBSTANDARDIUNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> � - 6tur.y <br /> 2-s - 864 -- a S GO V <br /> omp <br /> plaint Reviewed y: ^ + ,r, ate: pate y: ate: <br /> 5104.rpt L 6(� <br />