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!� Complaint Investigation Form Report#:5104 <br /> COMPLAINT IDJ C00029487 Site Location: 530 W LODI AVE Account ID: AR0000394 <br /> Receivedby: EE0007541 FIELD Received Date: 12/3/2008 Print Date: 12/3/2008 4:36:23PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 1213/2008 <br /> i <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :SUSAN WATT Home Phone 209-366-4001 <br /> Address Work Phone <br /> Nature of complaint <br /> AROUND 6:16 PM ON 11128108, (C)PURCHASED TURKEY LUNCH BOX SANDWICH FROM DELI FOR HER 17 YR OLD DAUGHTER. ABOUT 20 <br /> MINUTES AFTER EATING,(C)'S DAUGHTER BECAME NAUSEOUS,AND ABOUT 11:30 SHE BECAME ILL WITH VOMITING,DIARRHEA, <br /> STOMACH CRAMPS,AND NAUSEA. (C)TOOK HER DAUGHTER TO LODI MEMORIAL HOSPITAL,WHERE SHE WAS ADMITTED. THE . <br /> TREATING DOCTOR TOLD(C)HER DAUGHTER HAD FOOD POISONING,AND WAS GIVEN ANTI-BIOTICS. DAUGHTER WAS KEPT IN <br /> HOSPITAL UNTIL 11130/08. (C)COMPLAINED TO STORE EMPLOYEE NAMED"GERALD." (C)STATED THAT SHE HAS SEEN EMPLOYEES <br /> CHANGE THE EXPIRATION DATES ON THEIR DELI SANDWICHES. "'(C)REQUESTS A CALL FROM INSPECTOR. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000395-SAVE MART#655 Owner: OW0000369-SAVE MART SUPERMARKETS <br /> Site Location 530 W LODI AVE RP/DBA <br /> LODI,CA 95241 RP Address 1800 STANDIFORD AVE <br /> Cross Street LODI MODESTO,CA 95350-0180 <br /> Mailing Address: PO BOX 4278 Billing Address PO BOX 4278 <br /> MODESTO,CA 95352 MODESTO,CA 95352-4278 <br /> Nome Phone ;209-577-1600 <br /> Phone 209-339-7170 Work Phone ;209-574-6275 <br /> District 004-VOGEL,KEN Location Code 02-LODI <br /> APN 03319037 <br /> Date Abated ����_p 8 inspector � .� <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> f <br /> Complaint Status Code: a[ <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER 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 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 06-EHO PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28- OODBORNE ILLNESS-Unconfirmed I No Major Violations <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations IdentifietOmplaint HistOU <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint Ached But Not <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint Scanned <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 510 .rpt <br /> I <br />