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s, <br /> V Complaint Investigation Form Report#:5104 <br /> GDMPLAINT ID: C00037114 Site Location: 244 W HARDING WAY AccountlD: AR0001553 <br /> Receivedby: EE0001788 CASTANEDA Received Date: 10/11/2013 PrintDato: 10/11/2013 1:57:28PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 10/11/2013 <br /> ProaramlFlement Code:1600-FOOD PROGRAM <br /> Complainant: :BRANT Home Phone 209-430-9816 <br /> Address Work Phone <br /> Mail Address <br /> Nature ofcomplaint: <br /> (C)PURCHASED DONUTS THAT HAD MOLD ON THEM. <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 1 Correspondence O-Other EH Unit P-Phone <br /> I-Internet 1 Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0001554-FRESH&EASY MINT MARKET Owner: OW0001214-TD RICO LLC <br /> Site Location 244 W HARDING WAY RP/DBA FRESH&EASY MINI MARKET <br /> STOCKTON,CA 95204 RP Address <br /> <br /> <br /> <br /> <br /> Phone :209-466-1734 Work Phone <br /> District 001-VILLAPUDUA Location Coda 01-STOCKTON <br /> APN 13708014 <br /> Date Abated y LJ' i Inspector ID <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: O <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 Reqired-See Program Record File <br /> 0 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 SUBSTANDARDlUNSECURED-See Housing File <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />