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fComplaint Investigation Form Report#: 5104 <br /> �_ r <br /> OOM T ID: C00035496 Site Location: 34.0 W GRANT LINE RD Account ID: AR0006573 <br /> Received by: EE0090753 MARTINEZ Received Date: 912112012 Print Date: 9/21/2012 12:24:10PM <br /> Assigned To: EE0001420 NISSIM Assigned Date: 9/21/2012 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> ON 9120 @ 8 PM SHE BOUGHT TURKEY FROM THE DELI&SHE NOTICED BROWN MARKINGS ON THE OUTSIDE&YELLOW ON THE INSIDE <br /> OF THE MEAT <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> ————— I-Internet l Email S-Sheriff's Office <br /> ------- -------------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> i <br /> Facility:FA0005789-JUANITA MARKET#4 Owner: OW0004600-JUANITA MARKET INC <br /> Site Location 340 W GRANT LINE RD RP/DBA JUANITA MARKET44 i <br /> TRACY,CA 95376 RPAddress 93 SOUTHWEST BLVD <br /> Cross Street GRANT LINE ROHNERT PARK,CA 94952 <br /> f Mailing Address: 946 CAULFIELD LN Billing Address 946 CAULFIELD LN <br /> PETALUMA,CA 94952 PETALUMA,CA 94952 <br /> Nome Phone :707-762-1361 <br /> i <br /> Phone ;209-833-0407 Work Phone <br /> District : Location Code j <br /> APN 23J03U27 <br /> I <br /> Date Abated �_ '/ y' 127InspectorID#: <br /> � <br /> --------------------------���```--- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> I 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified t <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Regired-See Program Record File I <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE Response <br /> i <br /> 97-Disaster Planningand Res <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> f 10-POSTED SU BSTAN DARDIU NSECU RED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> t <br /> 5104.rp1 <br />