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i <br /> Complaint Investigation Form , <br /> Report#:5104 <br /> COMPLAINT ID: C00015858 Site Location: 1950 W 11TH ST Account ID: AR0002542 <br /> Received by: EE0000099 Frost Received Date: 4/27/2001 <br /> Assigned To: EE0003497 QUINLIN Assigned Date: 4127101 <br /> Pro ram/Element Code: 1619-RETAIL MKT>1000 SOFT(MULTIPLE DEPTS) <br /> Complainant: <br /> <br /> Nature of complaint: <br /> BOUGHT COOKED CHICKEN ROASTED,WIFE AND CHILD BEGAN VOMITING AND HAD DIARRHEA. IT'STARTED A COUPLE HOURS <br /> AFTER EATING.THESE PEOPLE ARE NEIGHBORS OF C00015857. <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council E-Code Enforcement <br /> M-MaillCorrespondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION i. <br /> Facility: FA0002980-SAFEWAY STORES#1264 Owner: OW0000429-SAFEWAY INC <br /> RP/DBA: <br /> Site Location. 1950 W 11TH ST I- <br /> RP Address: 47400 KATO RD <br /> TRACY,CA 95376 <br /> FREMONT,'CA 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-BEDFORD, LYNN Location Code 03-TRACY <br /> APN <br /> Date Abated <br /> Inspector <br /> i' <br /> Send Referral to: <br /> Referral Address: <br /> Referral Letter Sent by: <br /> Date: <br /> i <br /> Complaint Status Code: y y <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-Leiter Sent To Tenant <br /> 04-Notice To Abate Issued 17-15-Day Leiter Sent j <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/Unable To Verify 51-Lead Hazard Work Plan Submitted(2) <br /> 09-Foodbome 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) t <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant WlSoil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> i <br /> 0104.rpt <br />