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Complaint Investigation Form Report* 5104 <br /> COMPLAINT ID: C00036914 Site Location: 1230 W KETTLEMAN LN AccountlD: AR0014570 <br /> Received by: EE0001788 CASTANEDA Received Date: 9/3/2013 Print Date: 9/3/2013 3:57:15PM <br /> Assigned To: EED005362 WIESEMAN Assigned Date: 9/3/2013 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :ANGEL Nome Phone : 916-212-6385 <br /> Address Work Phone . <br /> Mail Address <br /> Nature of complaint: <br /> (C)WENT TO FACILITY ON 911113 AND WAS SERVED CUP OF COFFEE WITH FOUR BABY COCKROACHES IN IT,CALL BACK AFTER <br /> INSPECTION <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referrai B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mall/Correspondence O-Other EH Unit P-Phone <br /> I-Internet!Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0003926-IHOP Owner: OW0006538-LAXMI US 1234 FOOD CORP <br /> Site Location 1230 W KETTLEMAN LN RP/DBA IHOP <br /> LODI,CA 95240 RP Address 2213 KELSO PEAK AVE 170 <br /> Cross Street KETTLEMAN BAKERSFIELD,CA 93304 <br /> Mailing Address: 1230 KETTLEMAN LN Billing Address 1230 KETTLEMAN LN <br /> LODI,CA 95240 LODI,CA 95240 <br /> Home Phone <br /> Phone :209-369-1361 EXT: 0 Work Phone <br /> District 004-VOGEL,KEN Location Code 02-LODI <br /> APN 06004001 <br /> Date Abated Inspector ID#.- <br /> Send <br /> :Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: � <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 /> 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 CEosed <br /> 10-POSTED SUBSTAN DARDIU N SECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104 rpt <br />