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Complaint Investigation Form Report#:5104 <br /> 3 ; <br /> COMOLAIlST ID: C000401 Site Location: 1110 KETTLEMAN LN Account ID: AR0020402 <br /> Received by: EE0000467 CARRUESCO Received Date: 8/10/2015 Print Date: 8/10/2015 1 1:51:08AM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 8/10/2015 <br /> Proaram5,6gment Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> COCKROACHES AROUND THE CASH REGISTER.PATIO DOOR WAS OPEN DURING ENTIRE VISIT, <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 /> 1-Internet l Email S-Sheriffs Office <br /> -- -------------------------------- - ------------- <br /> FACILITY <br /> --------- --------- ---- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000175-WOODBRIDGE PIZZERIA OF LODI Owner: OW0009703-WOODBRIDGE PIZZERIA INC <br /> Site Location 1110 W KETFLEMAN LN STE 2 RPMBA WOODBRIDGE PIZZERIA OF LODI <br /> LODI,CA 95240 RP Address PO BOX 14 <br /> Cross Street WOODBRIDGE,CA 95258 <br /> t <br /> Mailing Address: PO BOX 14 Billing Address PO BOX 14 <br /> WOODBRIDGE,CA 95258 WOODBRIDGE,CA 95258 <br /> Home Phone :209-478-2746 EXT: HOME <br /> Phone :209-334-1042 Work Phone :209-003-1528 EXT: CELL <br /> District 004-WINN,CHARLES Location Code <br /> APN 06037002 <br /> Date Abated S Inspector ID#: I��wy VWU <br /> - ---------------------------------- <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 /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Regired-See Program Record File <br /> 0 -DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 6- HD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 0 -REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File ~ <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omp aint Reviewed by: ate: Updated by: ate: <br /> 5104.rp1 <br /> L_ <br />