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Complaint Investigation Form Report# 5104 <br /> COMPLAINT ID: 000034315 Site Location'. 1230 W KETTLEMAN LN AccountlD: AR0014570 <br /> Received by EE0090753 MARTINEZ Received Date 11/14/2011 Print Date 11/15/2011 8'.20:20A%4 <br /> Assigned To EE0001399 YOAKUM Assigned Date, 11/15,12011 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant' : SANDY Nome Phone 209-712-5387 <br /> Address Work Phone <br /> E-Mail Address <br /> Nature of complaint: <br /> {C)STATED THE WHOLE FACILITY SMELLS OF RAW SEWAGE THE SMELL WAS COMING FROM BOTH MENS&WOMENS RESTROOMS AND <br /> THE KITCHEN AREA. <br /> Complaint Mode: P Cornplauit Mode Codes A-Agency Referral H-Bd of Supervisors i City Council C-Counter F•Fax <br /> E-Cane Eirforcement M-Mail,'Gorrespondence O-other EH Unit P-Phone <br /> I-Internet 1 Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FAMI03926-11101' Chvncr', OW0006538-SEVLNTIfF N FORTY EIGHT CC?,INC <br /> Site rotation 12'1,1IC !,_I"i"H.FMAN1.N RRID3A IH()I' <br /> L(_ )I.(_A Q) 2-IU RP Address 25020SFANFORDAVL 170 <br /> Cross Street Ilk 1"I 1.I A,1 1N V,,11-EN CIA,CA 41355 <br /> Mailing Address ti 1,1-.i`CI.I_:'1,1N i.,N >AW;g Address 1230 KI'1'1'1_EMALN I,N <br /> X1)1. CA 95240 <br /> Nome Phone <br /> Pnooe 209-369-136t <br /> I•:1-N Location Code 02-L.ODI <br /> AFF il6fltl l�71 <br /> Onto a. tom;' C) '�lr�spector ICS <br /> Send R­rrol to Rererra7 Letter Sent by <br /> Referral AUuress Date <br /> Complaint S""ms Code: U1, <br /> Circle approji St:i,us <br /> 01 -FIELD ABATED 29-FCOQSORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATEL, 5.]-LEAD Assessment Performed-No Abatement Required <br /> 03-NAI SENT 52-LEAD Abatement Regired-See Program Record File <br /> 04-NOTICE TO Ari/,'l," ! '",l°'e l; 9r-Disaster Planning and Response <br /> o5-DA-ENFCRCEMEN1NITIATED V9-UNSPECIFIED-Old Complaint-No Original Found <br /> -)06 EHD FACILITY-scn Li,-,,,ad Pi�OGRAM FACILITY FILE CL-Case Closed <br /> REFERRED TO OTHER AGE,QCY <br /> 08-UNABLE TO VERIFY <br /> 1D-POSTED SUBSTANDARIT'U,NSLCURED-S=_, Huusing File <br /> 11-Multiple Cc,n;r',:.r:a - ':.L:D 1,`I iVE CASE# <br /> 12-DA Referred Complal-.;See VI:;z t jr.Tracking F=orm <br /> 15-ACTIVE HOL`S!f[' C ti;,E-NEV1'COPIIPLAINT seo ACTIVE CASE 9 <br /> 28-FOODH011,N:'_IL'._Ji Nc ;t Viclsticns l rntifieCl <br /> s�oa I <br />