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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00015243 Site Location: 1305 E MAIN ST Account ID: AR0001374 <br /> Receivedby: EE0000794 MATHEW Received Date: 11/29/2000 <br /> Assigned To: EE0003497 QUINLIN Assigned Date: 11/29/00 <br /> Proorem/Element Code: 1619-RETAIL MKT>1000 SQ FT(MULTIPLE DEPTS) <br /> Complainant: <br /> <br /> Nature of complaint: <br /> 22 MONTH OLD BABY DEVELOPED E.COLI HIS DATE OF ONSET 11-09-00. DIAGNOSED ON 11-14-00. <br /> CHILD NIBBLED ON BEAN SPROUTS PURCHASED FROM SAFEWAY ON 11-04-00. SALAD PREPARED NEXT DAY WITH BEAN SPROUTS <br /> AND SISTER IN LAW WHO CONSUMED THIS ALSO BECAME ILL. <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council E-Code Enforcement <br /> M-Mail/Correspondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0002980-SAFEWAY STORES#1264 Owner: OW0000429-SAFEWAY INC <br /> RP/DBA: <br /> Site Location: 1950 W 11TH ST <br /> RD <br /> TRACY,CA 95376 RP Address: NTT, <br /> FREM A <br /> REMOCA 94537 <br /> Mailing Address: PO BOX 29096 <br /> PHOENIX,AR 85038-9096 Billing Address:: PO BOX 29096 <br /> PHOENIX,AR 85038-9096 <br /> Phone: 1st: 209-239-9327 Phone: Hm: 209-239-9327 <br /> Wk: 209-239-9327 <br /> District 005-CABRAL,ROBERT Location Code 03-TRACY <br /> APN <br /> Date Abated <br /> Inspector <br /> Send Referral to: <br /> Referral Address: <br /> Referral Letter Sent by: <br /> Date: //,, <br /> Complaint Status Code: v7 <br /> 01 -Field Abated 10-Substandard Property-See HOUSING ABATEMENT 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 50-Lead Hazard Evaluation Required(1) <br /> � EHD Permit Facility-See Linked Premise File 52-Lead Hazard Abatement in Progress(3) <br /> -Referred To Other Agency 53-Lead Hazard Visual Inspect Satisfactory(4) <br /> 08-Invalid/Unable To Verify 51 -Lead Hazard Work Plan Submitted(2) <br /> 09-Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55-Lead Hazard Monitoring Schedule (6) <br /> 12-Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete (7) <br /> 13- Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant W/Soil Contamination <br /> 14- Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> 0104.rpt <br />