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r r Complaint Investigation Form U Report#:5104 <br /> COMPLAINT ID: C00018200 Site Location: 1950 W 11TH ST Account ID. AR0002542 <br /> Received by: EE0009058 LOWE Received Date: 1012312002 <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 10/23/2002 <br /> Program/Element Code: 1619-RETAIL MKT>1000 SQ FT(MULTIPLE DEPTS) <br /> Complainant: <br /> <br /> Nature of complaint: <br /> ON 10/15/02(C)ATE FRIED CHICKEN, FRIED CHICKEN RICE.ON 10/17/02 BECAME ILL WITH STOMACH CRAMPS, DIARRHEA,AND ON <br /> 10;21102 DIAGNOSISED WITH SALMONELLA. 1 <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral 8-8d 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 RP Address: 47400 KATO RD <br /> TRACY,CA 95376 <br /> FREMONT,CA 94537 <br /> Mailing Address: PO BOX 29096 <br /> Billing Address:: PO BOX 29096 <br /> PHOENIX,AR 85038-9096 <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 l <br /> Date Abated 10 <br /> Inspector "3J'72 Lf <br /> Send Referral to: <br /> Referral Address: <br /> Referral Letter Sent by: <br /> Date: <br /> Compfaint Status Code: O <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 /> 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) <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 W1Soil Contamination <br /> 14-Enforcement Case-Transferred To ER Fite 58-Lead Hazard Case-See Active File For This Site <br /> 5104 rpt <br />