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Complaint Investigation Form <br /> Report#:5104 <br /> COMPLAINT ID: C00035912 Site Location: 140 E HARDING WAY AccountlD: AR0001468 <br /> Receivedby: EE0090753 MARTINEZ <br /> Received Date: 1/2212013 Print Date: <br /> Assigned To: EE0006213 PEDRAZA 1/22/2013 4:04:11PM <br /> Assigned Date: 1/2212013 <br /> ProoramQ1,ement Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> <br /> <br /> Nature of cog Taint: <br /> ON SUNDAY 1120 @ 4 PM(C)'S WIFE NOTICE A OLDER FEMALE EMPLOYEE WRAPPING SILVERWARE INTO NAPKINS THEN GO USE THE <br /> RESTROOM BUT SHE DID NOT WASH HER HANDS AFTER BUT WENT TO CONTINUED WRAPPING THE SILVERWARE. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors'/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> 1-InternetI Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION — <br /> Facility:FAU001469-GONGS RESTAURANT Owner: OW0001146-LEI,PAUL <br /> Site Location 140 E HARDING WAY RP/DBA GONGS RESTAURANT <br /> STOCKTON,CA 95204 RP Address <br /> <br /> <br /> <br /> Home Phone <br /> Phone :209-464-0953 Work Phone <br /> District 001-VILLAPUDUA Location Code 01-STOCKTON <br /> APN 13902///015 /43 <br /> Date AbateInspector ID#: -- ——— —--——— - ——— — <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: NO <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <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 <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />