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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00035417 Site Location: 2449 W KETTLEMAN KN Account ID: AR0019835 <br /> Received by: EE0090753 MARTINEZ Received Date: 8/31/2012 Print Date: 8/31/2012 9:59:46AM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 8/31/2012 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> <br /> <br /> <br /> Mature of complaint: <br /> PERSON DIAGNOSED WITH VIBRIO.BOUGHT OYSTERS ON 8115 FROM THIS FACILITY <br /> ""FAX BACK TO PHS-SEE ATTACHED FAX** <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail r Correspondence O-Other EH Unit P-Phone <br /> 1-Internet I Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FAOOI2254-SAFEWAY 41648 Owner: OW0009310-SAFEWAY INC <br /> Site Location 2449 W KETTLEMAN LN RP/DBA SAFEWAY INC <br /> LODI,CA 95242 RP Address 5918 STONERIDGE MALL RD <br /> Cross Street PLEASANTON,CA 94588-3229 <br /> Mailing Address: PO BOX 29096 Billing Address PO BOX 29096 <br /> y PHOENIX,AZ 85038-9096 PHOENIX,AZ 85038-9096 <br /> 1 Home Phone ;925-467-3000 <br /> Phone ;209-367-7875 Work Phone 925-467-2217 <br /> District Location Code <br /> AP1V <br /> Date Abated Ct ` 2 Inspector ID#: <br /> -- - ------------------------------------------��- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: nlr. <br /> Circle appropriate Status Cade <br /> f 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 2a-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 /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 111 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rp1 <br />