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ilk Complaint Investigation Form Report#:5104 <br /> *�C0 INT ID: C00025942 Site Location: 1347 S EL DORADO ST Account ID: AR0007910 <br /> Received by: EE0007541 FIELD Received Date: 2/27/2007 PrintDate: 2/27/2007 2:57:08PM <br /> Assigned 7o: EE0001699 YOAKUM AssignIed Date: 2/27/2007 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :LAVIN !-lame Phone : 209-464-2672 <br /> Address Work Phone <br /> Nature of complaint:-- <br /> ON <br /> oin laint:ON 2120107 AROUND 8 PM,(C)ATE AT FACILITY WITH HIS SON. (C)ORDERED THE TOP MENU ITEM,WHICH CONTAINED RAW SHRIMP. <br /> AROUND 9 PM 2122104, (C)BECAME ILL WITH VOMITING AND DIARRHEA,WHICH LASTED UNTIL 3 AM. (C)DID NOT CONTACT FACILITY OR <br /> GO TO THE DOCTOR. SON DID NOT EAT SHRIMP OR BECOME ILL. -(C)REQUESTS A CALL BACK FROM INSPECTOR AFTER <br /> INSPECTION.`"* <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors i City Council C-Counter <br /> E-Code Enforcement M-Mail[Correspondence 0-Other EH Unit P-Phone <br /> FACILITY INFORMATION — OWNER INFORMATION <br /> Facility:FA0006409-RL GRULLENSE(TAQUERIA) Owner: OW0001107-GUERRERO,RAMON&MIQUEL <br /> Site Location 1347 S EL DORADO ST RPIDBA <br /> STOCKTON,CA 95206 RPAddress 1327 S WILSON WY <br /> STOCKTON,CA 95205 <br /> Mailing Address. 1331 S WILSON WAY Billing Address 1327 S WILSON WY <br /> STOCKTON,CA 95205 STOCKTON,CA 95205 <br /> Home Phone ;209-463-9242 <br /> Phone :209-463-9242 Work Phone ;209-463-6390 <br /> Dist+ict 001-GUTIERREZ,STEVE Location Code 01-STOCKTON <br /> APN 14716030 <br /> Date Abated a-'l�j-U� Inspector: , cep L��� <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 2 8 <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 /> 06-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- OODBORNE 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 Sent-Confirmed Complaint <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> C'0n1plaillt history <br /> flltached But Not <br /> Scanned <br /> 2" CON. ; . <br /> 5104.rpt <br />