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deComplaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00033847 Site Location: 7939 W 11TH ST Account ID: AR0002789 <br /> � r <br /> Received by, EE0090753 MARTINEZ Received Date: 7/19/2011 Print Date: 7/19/2011 3:04;36PM <br /> Assigned To: EE0001420 MENDE Assigned Date: 7/19/2011 <br /> Pm.gram/Elament Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint. <br /> (C)STATED SEWAGE IS BACKING UP EVERYWHERE IN THE FACILITY, PARKING LOT,AND ALSO INTO THE OTHER SUITES IN THIS <br /> BUSINESS. (APAR+ME#�hT�-Bt +NESS)- jq�k c• } 3~� ! r. �. <br /> complaint Mode: P Complaint Made Codes A-Agency Referral B-Bd of Sup' isors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Internet!Email S-Sheriffs Office <br /> -------------------------------------------------- <br /> FACILITY INFORMATION OWNER INFORMATION <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 11 TRACY,CA 95376 <br /> f."Ming Address: 7939 W 11TH ST Billing Address 311-GRANT LINE RD <br /> TRACY,CA 95376 TRACY,CA 95376 <br /> Home Phone <br /> Phone :209-832-3392 Work Phone <br /> District 005-ORNELLAS,LEROY Location Code 99-UNINCORPORATED AREA <br /> APV 25014009- <br /> Date <br /> 5014009Date Abated Inspector ID#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 0 SO <br /> Circle appropriate Status Code <br /> 01 -FIELO ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> i <br /> 03-NAI SENT 52-LEAD Abatement Regired-See Program Record File <br /> 04-NOTICE TO ABATE ISSUED 97-Disaster Planning and Response <br /> DA-ENFORCEMENT ACTION INITIATED 99-UNSPECIFIED-Old Complaint-No Original Found <br /> -EH` FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDlUNSECURED-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 /> 5104.rpi <br />