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it <br /> i <br /> I Report#:5104 <br /> �. Complaint Investigation Form '., <br /> COMPLAINT ID: C00015757 Site Location: 200 W KETTLEMAN LN J Account ID: AR0009158 <br /> Received by: EE0000099 Frost Received Date: 4/6/2001 <br /> Assigned To: EE0000467 CARRUESCO Assigned Date: 419101 <br /> Program/Element Code: 1625-RESTAURANT/BAR 51-100 SEATS <br /> <br /> <br /> <br /> Nature of complaint.- <br /> FAT <br /> omplaint.AT 1:20 PM TOOK OUT BEEF&BROCCOLI,THERE WAS A COUPLE BUGS IN FOOD.HARD SHELL BACK 4 LEGS,THEY WERE DEAD. <br /> fl �, <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council E-Code Enforcement <br /> M-Mail/Correspondence O-Other EH Unit C-Counter P-Phone <br /> i <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0006726-TERIYAKI TIME WOK EXPRESS Owner: OW0006097-KONG,SARAY <br /> i <br /> RP/DBA: TERRIYAKI TIME WOK EXPRESS <br /> Site Location: 200 W KETTLEMAN LN <br /> RP Address: 9019 STACEY CT <br /> LODI,CA 95240 <br /> STOCKTON,CA 95209 <br /> Mailing Address: 200 W KETTLEMAN <br /> LODI,CA 95240 Billing Address:: 9019 STACEY CT <br /> STOCKTON,CA 95209 <br /> Phone: 1st: 209-333-7098 Phone: Hm: 209-951-2411 i <br /> Wk: 209-333-7098 <br /> District 004-SEIGLOCK,JACK Location Code 02-LODI <br /> APN /� 1 <br /> Date Abated <br /> Inspector <br /> Send Referral to: <br /> Referral Address: <br /> i <br /> Referral Letter Sent by. <br /> Date: <br /> Complaint Status Code: u� g <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 /> (8) Invalid/Unable To Verify 51 -Lead Hazard Work Plan Submitted(2) <br /> MFoodborne 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 W/Soil Contamination <br /> 14- Enforcement Case-Tra nsferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> 0104.rpt <br />