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it <br />!: Report#:5104 <br /> Complaint Investigation Form <br /> COMPLAINT ID: CO0013874 Site Location: 250 N HUNTER Account ID: AR0001787 <br /> Received by: EE0000099 Frost Received Date: 415!2000 <br /> Assigned 7o: EE0009157 ELAI_ Assigned Date: 415100 <br /> Program/Element Code:- FOOD PROGRAM <br /> Complainant: <br /> <br /> Nature of complaint: <br /> BARTENDER PULLED OUT BOTTLE OF ALCOHOL AND IT WAS BLACK AND MOLDY. WOMENS BATHROOM HAS NO SOAP,BAR IS DIRTY <br /> Complaint Mode Complaint Mode Codes A-Agency Referr• B-Bd of Supervisors/Cit) C-Count( E-Code Enforcem( <br /> M-MaillCorrespondi O-Other EH Unit P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0001787-DAVOLIS AVENUE INN OW0001394-DAVOLI,ALFRED <br /> Site location: 250 N HUNTER ST DBA: DAVOLIS AVENUE INN <br /> STOCKTON,CA 95202 RP Address: 6420 N ELDORADO <br /> Mailing Address: 250 N HUNTER ST <br /> STOCKTON,CA 95202 Billing Address: 6420 N EL DORADO <br /> Phone: i st: 209-466-6193 <br /> STOCKTON,CA 95207 <br /> Phone: <br /> Wk: <br /> .S <br /> District: 003-SIMAS,EDWARD Location Code: 01 -STOCKTON <br /> APV: <br /> Date Abated: <br /> Inspector: <br /> Send Referral to: <br /> Referral Letter Sent by: <br /> Referral Address: Date: <br /> Complaint Status Cade: <br /> 01 -Field Abated 10-Substandard Property-See HOUSING ABATEMENT File <br /> 02-Office Abated 15-Active Housing Case-New Complaint See Active Case# <br /> 03-NAI Sent 16- Letter Sent To Tenant <br /> 04-Notice To Abate Issued 17- 15-Day Letter Sent <br /> 05-Enforcement Action Initiated 50- Lead Hazard Evaluation Required(1) <br /> 06-EHD Permit Facility-See Linked Premise File 52- Lead Hazard Abatement in Progress(3) <br /> 07-Referred To Other Agency 53-Lead Hazard Visual Inspect Satisfactory (4) <br /> 08-Invalid/Unable To Verify 51 -Lead Hazard Work Plan Submitted(2) <br /> 09-Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55-Lead Hazard Monitoring Schedule (6) <br /> 12- Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete (7) <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant WlSoil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> i <br /> I <br /> 0104.rp1 <br />