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Complaint Investigation Form <br /> Report#:5104 <br /> COMPLAINT ID: 000036279 Site Location: 2425 W KETTLEMAN LN ACcountlD: AR0020965 <br /> Received by: EE0003611 GIRARDI Received Date: 4/15/2013 <br /> Print Date." 4/1512013 4:06:32PM <br /> Assigned To: EE0004589 LINHARES <br /> Assigned Date: 4/1$/2013 <br /> Pro 'Element Code:1600-FOOD PROGRAM <br /> Complainant. :MARY CABRERRA <br /> Address Home Phone 209-368-5626 <br /> Work Phone <br /> Mail Address <br /> Nature of complaint: <br /> DRIVE THRU WORKER PLACED FOOD INTO A BAG WEARING A BAND AID WITH OUT GLOVES.THE(C)RETURNED THE FOOD TO CASHIER <br /> &PLACED THE ORANGE JUICE BACK INTO THE REFRIGERATOR <br /> Complaint Mode: p Complaint Mode Codes A-A en Referral <br /> 9 cS+ B-Bd of Supervisors!City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> — —— ——`—— — I-Internet 1 Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0012662-JACK IN THE BOX(#4301 Owner: OW0000819-YADAV,ANIL <br /> Site Location 2425 W KETTLEMAN LN RP/DBA <br /> LODI,CA 95242 RPAddress <br /> <br /> <br /> <br /> <br /> <br /> Drsfnct _ Location Code <br /> APN <br /> Date Abated l 44 -1 7 r3 Inspector ID <br /> .._--___------------- - <br /> Send Referral to Referral Letter Sent by <br /> Referral Address <br /> 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 /> 0 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 Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />