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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00039631 Site Location: 1110 N MAIN ST Account ID AR0000792 <br /> Received by: EE0001788 CASTANEDA Received Date. 5/4/2015 Print Date. 5/5/2015 10:26:54AM <br /> Assigned To: EE0004589 LINHARES Assigned Date 5/4/2015 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: CHANTEL Home Phone : 209-824-5702 <br /> Address Work Phone :209-676-1045 <br /> -Mail Address <br /> Nature of complaint: <br /> COMPLAINANT ATE AT RESTAURANT ABOUT 2 WEEKS AGO,ORDERED CHICKEN SUPER BURRITO AND A SODA AT THE DRIVE THRU. <br /> COMPLAINANT WAS DIAGNOSED AND HOSPITALIZED WITH SALMONELLA ABOUT A WEEK LATER. PLEASE CALL COMPLAINANT AFTER <br /> INSPECTION, <br /> Complaint Mode. P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet!Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000794-TAQUERIA LA ESTRELLA Owner: OW0017389-FONSECA,JUAN <br /> Site Location 1 110 N MAIN ST RP/DBA TAQUERIA LA ESTRELLA <br /> MANTECA,CA 95336 RP Address <br /> <br /> <br /> <br /> <br /> Phone :209-823-9000 Work Phone <br /> District 003-BESTOLARIDES,STEVE Location Code 04-MANTECA <br /> APN 21821023 <br /> Date Abated 5— — Inspector/D#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: '7 <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omp aint Reviewed by: /) i ate: p ate y: Date <br /> 5104 rpt <br />