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w Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00031324 Site Location: 1347 S EL DORADO ST Account ID: AR0007910 <br /> Receivedby., EE0000467 CARRUESCO Received Date: 12/9/2009 Pant Date: 12/9/2009 2:59:54PM <br /> Assigned To: EE0003474 VEGA Assigned Date: 12/9/2009 <br /> Pro ram/Elern-t Code:1600-FOOD PROGRAM <br /> Complainant: :DONELLE TAMAYO-PH CD Nome Phone <br /> Address Work Phone <br /> E-Mail Address <br /> Nature of com laint. <br /> A CUSTOMER ATE ON 11121/09 A BEEF BURRITO, RICE, BEANS,SALSA, LIMES,AND RADISHES. BECAME ILL W/SALMONELLA.SYMPTOMS <br /> 11/22/09 DIAGNOSED 11/30109. 'FAX REPORT TO DONELLE TAMAYO 468-8222. <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors!City Council C-Counter F-Fax <br /> E-Cade Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> -- ---------- ------------------ — ----------- <br /> FACILITY INFORMATION OWNER INFORMATION— — <br /> Facility:FA0006409-EL GRULLENSE(TAQUERIA) Owner: OW0001107-GUERRERO,RAMON&MIQUEL <br /> Site Location 1347 S EL DORADO ST RPIDBA <br /> STOCKTON,CA 95206 RP Address 1327 S WILSON WY <br /> Cross Street ELDORADO STOCKTON,CA 95205 <br /> Mailing Address: 1331 S WILSON WAY Billing Address I327 S WILSON WY <br /> STOCKTON,CA 95205 STOCKTON,CA 95205 <br /> Nome Phone :209-463-9242 <br /> Phone :209-463-9242 Work Phone :209-463-6390 <br /> District 001 -VILLAPUDUA <br /> Location Code 01 -STOCKTON <br /> APN 14716030 <br /> Date Abated —I s- —O q Inspector. <br /> --------- --------------------`-- <br /> ----------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: f_ Complaint History <br /> Attached But Not; <br /> Circle appropriate Status Code Scanned <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement Regired-See Program Record File <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> V6 EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 7-REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 51 .rpt <br />