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�.. i Report#:5104 <br /> f... Complaint Investigation Form <br /> t <br /> COMPLAINT ID: C00015857 Site Location: 1950 W 11TH ST `Account ID. AR0002542 <br /> i <br /> Received by: EE0000499 Frost <br /> Received Date: 4!2712001 <br /> Assigned To: EE0003497 QUINLIN Assigned Date: 4127101 <br /> Program/Element Code: 1619-RETAIL MKT>1000 SQ FT(MULTIPLE DEPTS) <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> PURCHASED ROASTED CHICKEN TUESDAY NIGHT,COMPLAINANTS HUSBAND&9 MONTH OLD CHILD BECAME ILL WITH VOMITING, <br /> DIARRHEA. <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-lid of Supervisors/City Council E-Code Enforcement <br /> M-MaiiiCorrespondence 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 /> RPAddress: 47400 KATb RD <br /> TRACY;CA 95376 <br /> FREMONT;CA 94537 <br /> Mailing Address: PO BOX 29096 <br /> Billing Address:: PO BOX 29096 ' l: <br /> PHOENIX,AR 85038-9096 PHOENIX,AR 85038-9095 <br /> Phone:1st: 209-239-9327 Phone: Hm: 209-239-9327 <br /> Wk: 209-239-9327 <br /> District 005-BEDFORD, LYNN <br /> Location Code 03-TRACY I <br /> APN <br /> Date Abated 1 <br /> Inspector i o <br /> } <br /> Send Referral to: i <br /> Referral Address: <br /> `i <br /> Referral Letter Sent by.- <br /> Date., <br /> y.Date: <br /> li <br /> Complaint Status Code: I <br /> t <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 f- <br /> 04-Notice To Abate Issued 17-15-Day Letter Sent i <br /> 05-Enforcement Action Initiated 50-Lead Hazard Evaluation Required(1) <br /> 06-EHD Permit Facility-See Linked Premise File 52-Lead Hazard Abatement in Progress(3) <br /> 07-Referred To Other Agency 53-Lead Hazard Visual Inspect Satisfactory(4) <br /> 08-Invalid I 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) i! <br /> 12-Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete(7) j <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant W1Soil Conlami nation <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> I <br /> 0104 rpt <br />