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r Complaint Investigation Form Report#: 5104 <br /> COMPLAINT 11): C00037435 Site Location: 140 E HARDING WAY Account 1D. AR0001468 <br /> Receivedby EE0008999 HUYNH Received Date. 1!712014 Print Date 1/7/1014 4:23.18PM <br /> Assigned To. EE0008999 HUYNH AssrgnedDate. 117/2014 <br /> ProgramiElement Code.1600-FOOD PROGRAM <br /> Complainant: ANONYMOUS Home Phone <br /> Address Work Phone <br /> Mail Address <br /> Nature of complaint: <br /> OBSERVED DEAD RODENTS IN THE FACILITY, <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/Correspondence O-Other EH Unit P-Phone <br /> t-Internet!Email S-Sherift OfFce <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0001469-GONGS RESTAURANT Chvner OW0001146-LEI,PAUL <br /> Site Location 140 E HARDING WAY RP/DBA GONGS RESTAURANT <br /> STOCKTON,CA 95204 RP Address 5207 BARBADOS CT <br /> Cross Street HARDING STOCKTON,CA 95210 <br /> Mailing Address 140 E HARDING WAY Billing Address 5207 BARBADOS CT <br /> STOCKTON,CA 95204 STOCKTON,CA 95210 <br /> Home Phone <br /> Phone :209-464-0953 Work Phone <br /> District Location Code <br /> APN 139020 15 <br /> Date Abated 1< / /` 4, lnspedor 1D (1 <br /> Send Referral to Referral Letter Sent by <br /> Referral Address — Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE # <br /> 01 FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 13-NAI SENT 50-LEAD Assessmen t Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Cl osed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multipie Complaints -SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104.rpi <br />