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*IMP <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00032998 Site Location: 7939 W 11TH ST Account ID: AR0002789 <br /> Received by: EE0000467 CARRUESCO Received Date: 12/28/2010 Print bate:12/29/2010 8:49735AM <br /> Assigned To: EE0001420 MENDE Assigned Date: 12/28/2010 <br /> Pro ram/Element Code 1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> E-Mail Address <br /> Nature of complaint <br /> NO RUNNING WATER MEN'S RESTROOMS,COCKROACH INFESTATION,DRIPPING WATER ON CUSTOMERS,CATS BEING FED BY OWNERS <br /> IN THE KITCHEN, FISH BEING CAUGHT BY OWNERS IN CANAL AND BEING SERVED. <br /> Complaint Mode, P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Intemet t Email S-Sherifrs Office <br /> ————— ———— —————— —————————— ———-- <br /> FACILITY INFORMATION OWNER INFORMATION w <br /> Facility:FA0003221-JACKS PLACE Owner: OW0002400-MAH,GUEY JACK <br /> Site Location 7939 W 11TH ST RP/DBA JACKS PLACE <br /> TRACY,CA 95376 RP Address 31 E GRANT LINE RD <br /> Cross Street l i TRACY,CA 95376 <br /> Mailing Address: 7939 W 11 TH ST Billing Address 31 E GRANT LINE RD f <br /> TRACY,CA 95376 TRACY,CA 95376 i <br /> Home Phone i <br /> Phone :209-832-3392 Work Phone :209-N32-3199 <br /> District 005-ORNELLAS,LEROY Location Code 99-UNINCORPORATED AREA <br /> APN 25014009 <br /> Date Abated 12-�ZQI— ra Inspector: <br /> -- ----- ----- ------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: OG <br /> Circle appropriate Status Code <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-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY RLE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 1 <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-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.rp1 <br />