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W Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00032340 Site Location: 1950 W 11TH ST Account ID: AR0002542 <br /> Received by: EE0001699 YOAKUM Received Date: 7116/2010 PrintDate: 7/19/2010 8A 8:46AM <br /> Assigned To: EE0001699 YOAKUM Assigned Date: 7/19/2010 <br /> i <br /> Program/Element Code.1600-FOOD PROGRAM <br /> Complainant. ; <br /> <br /> <br /> Nature of complaint: <br /> POWER OFF AT 12 ON 7116110 <br /> Complaint Mode., R Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone I <br /> ---1-1 nternet I Email S-Sheriffs Office i <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002980-SAVE MART 490 Owner: OW0000369-SAVE MART SUPERMARKETS <br /> Site Location 1950 W 11TH ST RPIDBA : <br /> TRACY,CA 95376 RP Address 1800 STANDIFORD AVE <br /> Cross Street ELEVENTH MODESTO,CA 95350-0180 <br /> Mailing Address., PO BOX 4278 Billing Address PO BOX 4278 <br /> MODESTO,CA 95352-4278 MODESTO,CA 95352-4278 <br /> Home Phone ;209-577-1600 <br /> Phone :209-577-1600 Work Phone :209-574-6275 <br /> District 005-ORNELLAS,LEROY Location Code 03-TRACY <br /> APN 23402010 <br /> Date Abated 7-/(/d Inspector: J <br /> --- ------ -----------. ---------------------- — ---- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code./fY_ <br /> Circle appropriate Status Code L <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement Reqired-See Program Record File <br /> 03-NRI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> OB EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDIUNSECURED-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 /> 5104.rpi <br />