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Mr r Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00043110 Site Location: 1110 N MAIN ST Account ID. AR0000792 <br /> Receivedby: EE0000001 TURKATTE Received Date: 3/14/2017 Print Date: 3/14/2017 92053AM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 3/14/2017 <br /> Prooram/Element Code:1600-FOOD PROGRAM <br /> Complainant: :SARA COTTRELL Home Phone 209-985-5205 <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES ON 3/10/2017 AT 9:38 PM THEY WENT THROUGH THE DRIVE THROUGH AND ORDERED 4 SMALL CARNE ASADA <br /> TACOS WITH EVERYTHING,1 REGULAR SHREDDED CHICKEN BURRITO AND 2 BAGS OF CHIPS AND SALSA.UPON GETTING HOME, <br /> COMPLAINANT AND FIANCE NOTICED'THE SALSA TASTED A LITTLE FUNNY".COMPLAINANT CLAIMS THE SALSA TASTED AND SMELLED <br /> LIKE SOME SORT OF CLEANING SOLUTION.COMPLAINANT BECAME ILL WITH SYMPTOMS OF NAUSEA AND FEVER. <br /> Complaint Mode: I Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mall/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet/Email S-Sherifrs Office <br /> - ------------- - - - <br /> ----- --- -- --- ------- - <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0000794-TAQUERIA ILA ESTRELLA Owner: OWOO17389-FONSECA,JUAN F <br /> Site Location 1110 N MAIN ST RPIDBA <br /> MANTECA,CA 95336 RP Address <br /> <br /> <br /> <br /> <br /> <br /> District 003-BESTOLAR07ES,STEVE Location Code <br /> APN 21821023 <br /> Date Abated 3" I q—k—7 Inspector ID#: <br /> -------------- ------------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -Field Response-Violations Cited and Corrected 28- Ileged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Regired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Referred to Other Agency <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omp aint Reviewed by: Nnjj�lDI I ate-. Updated y: <br /> r J'eZ2' 7 <br /> 5104.rpt <br />