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` Report <br /> Complaint Investigation Form <br /> COMPLAINT ID: C00031913 Site Location: 5648 N EL DORADO ST AccountlD: AR0002179 <br /> Received by: EE0003952 JOHNSONIr�I s*0 Received Date: 4/1912010 Print Date: 4/19/2010 3:03:26PM <br /> Assigned To: EE0006213 PEDRAZA f Assigned Date: 4/19/2010 <br /> Proaram/Etement Code:1600-FOOD PROGRAM <br /> Complainant: :KIM <br /> HomePhone 209-331-7384 <br /> Address Work Phone <br /> E-Ma1!Address <br /> Nature of com Taint: <br /> (C)STATED BOTH SINKS IN KITCHEN ARE BACKED UP WITH DIRTY WATER;OIL IS UNCOVERED; MIXING MACHINE IS NOT CLEAN; BREAD <br /> IS LEFT UNCOVERED;MOP AND BROOM ARE STORED IN PLAIN SIGHT,AND KITCHEN IS"JUST PLAIN FILTHY." <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors i City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Internet!Email S-Sheriffs Office <br /> FACILITYIN FORMATION OWNER INFORMATION <br /> Facility:FA0062168-ST MARYS HIGH SCHOOL Owner: OW0001686-ST MARYS HIGH SCHOOL <br /> Site Location 5648 N EL DORADO ST RP/DBA ST MARYS HIGH SCHOOL <br /> STOCKTON,CA 95207 RP Address 5648 N EL DORADO <br /> Cross Street EL DORADO STOCKTON,CA 95207 <br /> Mailing Address: PO BOX 7247 Billing Address 5648 N EL DORADO <br /> STOCKTON,CA 95267-0247 STOCKTON,CA 95207 <br /> Nome Phone ! <br /> Phone :209-957-3340 Work Phone -JJ4Uj <br /> District 002-RUHSTALLER,LARRY Location Code 01 -STOCKTON <br /> APN 10209001 <br /> Date Abated � Inspector., <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder 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 Filo <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> 6 EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> -REFERRED TOOTH ER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-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 /> i <br /> k 51 .rpt <br /> f <br />