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Vvri <br /> Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00047127 Site Location: 530 W LODI AVE Account 10: AR0000394 <br /> Received by: EE0006213 PEDRAZA Received Date: 7/20/2018 Print Date: 7/20/2018 9:47:37AM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 7/20/2018 <br /> Program/Eement Code:1600-FOOD PROGRAM <br /> Complainant: :JOAN COLLINS-PHS Nome Phone <br /> Address Work Phone <br /> Mart Address <br /> Nature of com Taint: <br /> COMPLAINANT PURCHASED OYSTERS AND CONSUMED THEM ON 713118.ONSET SYMPTOMS ON 714118.SYMPTOMS INCLUDED CHILLS, <br /> DIARRHEA,VOMITING,SHAKES AND ABDOMINAL PAIN.COMPLAINANT SOUGHT MEDICAL ATTENTION ON 715118,DIAGNOSIS WAS VIBRIO. <br /> Complaint Mode: A 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 /> I-Internet!Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0000395-S-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 CRESCNET MODESTO,CA 95350 <br /> Mailing Address: 1800 Standiford Ave. i3itAng Address 1800 Standiford Ave. <br /> MODESTO,CA 95350 Modesto,CA 95350 <br /> Home Phone :209-574-6299 EXT: 111 <br /> Phone :209-339-7170 EXT: 0 Work Phone :209-577-1600 EXT: <br /> District 004-WINN,CHARLES Location Code 02-LODI <br /> APN 03319037 <br /> Date Abated – I �-` O Inspector!D#: 1'j L1.+z <br /> -------- <br /> -------———————————------------------------------ <br /> Send <br /> ------------------------------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSINC CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28 Ileged FBI-No Major Violations Identified $3-Septic system repaired <br /> 9-Alleged FBI-Major Violations Identified <br /> omp aint Reviewed by: ate: p ate y: ate: <br /> 5104.rpt <br />