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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00046464 Site Location: 2808 COUNTRY CLUB BLVD Account ID: AR0041583 <br /> Receivedby: EE000D467 CARRUESCO Received Date: 4/25/2018 Print Date: 4/25/2018 4:45:14PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 4/25/2018 <br /> ProaramrElement 929e1600-FOOD PROGRAM <br /> Complainant: :ARMITA Home Phone : 209470-0366 <br /> Address Work Phone <br /> -Mail Address <br /> Nature ofcomplaint: <br /> PET DOGS ALLOWED IN FOOD FACILITY <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Connespondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Once <br /> ________________ ________ ________ _______ ____________________ _____________________________________ <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0022709-SAFEWAY STORE#1769 Owner: OW0000429-SAFEWAY INC <br /> Site Location 2808 COUNTRY CLUB BLVD RPiDBA <br /> STOCKTON,CA 95204 RPAddress 5918 STONERIDGE MALL RD <br /> Cross Street 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 /> Home Phone :925467-3000 <br /> Phone :209-461-5555 Work Phone <br /> District 003-BESTOLARIDES,STEVE Location Code 01-STOCKTON <br /> APN 12118043 <br /> Date Abated �— `- —( Inspector to�V 'V i <br /> Send Referral to Referral Letter Sent b <br /> Referral Address Date: <br /> Complaint Status Code: b (/ <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Connected 50-LEAD Assessment Performed-No Abatement Required <br /> Q02 Once Response Only 52-LEAD Abatement Reqired-See Program Record File <br /> 6-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement AcOon Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> omp aintevlewe a e: p a e y: Date: <br /> 5104.rpt <br />