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Complaint Investigation Form Report#:5104 <br /> COMPLAIN b: C00033457 Site Location: 7939 W 11TH ST Account ID: AR0002789 <br /> Received by: EE0090753 MARTINEZ Received Date. 4/20/2011 Print Date: 4/20/2011 3:01:13PM <br /> Assigned To: EE0001420 MENDE Assigned Date: 4/20/2011 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> (C)STATED THERE ARE MANY COCKROACHES IN THE BAR AND THROUGHOUT THE FACILITY. THERE ARE CATS IN THE KITCHEN, <br /> BECAUSE BACK DOOR IS BEING LEFT OPEN. THE MEN'S RESTROOM TOILET DOES NOT FLUSH, NO TOWELS,AND NO HOT WATER. <br /> SEPTIC TANK IS SEEPING OUT THE TOP AND SMELLS VERY BAD. MANY OTHER ISSUES! -PLEASE CALL(C)FOR MANY OTHER ISSUES. <br /> I <br /> Complaint Mode: P Complaint Made Codes A-Agency Referral B-8d of Supervisors i City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail!Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> FACILITY <br /> ----------- ---.----------- -- <br /> FACILITY INFORMATION OWNER INFORMATION _ <br /> Facility:FA0003221-JACKS PLACE Owner: OW0002400-MAH,GUEY JACK <br /> 1 <br /> Site Location 7939 W 1 ITH ST RP/DBA JACKS PLACE <br /> TRACY,CA 95376 RP Address 31 E GRANT LAVE RD <br /> Cross Street 1 I TRACY,CA 95376 j <br /> Mailing Address: 7939 W I 1 TH ST Billing Address 31 E GRANT LINE RD <br /> TRACY,CA 95376 TRACY,CA 95376 <br /> Nome Phone <br /> Phone :209-832-3392 Work Phone <br /> District 005-ORNELLAS,LEROY location Code 99-UNINCORPORATED AREA <br /> APN 25014009 l <br /> Date Abated ._ r 1 ' Inspector: <br /> Send Referral to 1 l Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:V <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 /> 6 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 /> 51Q pt <br />