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Complaint Investigation Form Report#:5104 <br /> Account ID: AR0001708 <br /> COMPLAINT ID: 000023866 Site Location: 1616 E MARCH LN <br /> Receid Date: 1!1012006 Print Date: 111012006 l 1:42:30AM <br /> Received by: EE0000321 OLIVEIRA ve �C A NNku <br /> Assigned To: EE0006213 PEDRAZA Assigned Date: 1/10/2006 s7 illi <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Home Phone 209-931-5728 <br /> Complainant: :JUDY <br /> Work Phone <br /> Address <br /> Nature of com taint: <br /> N 115!06(C)PURCHASED A COFFEE CAKE MADE IN THE FACILITY BAKERY.SHE ATE PIECES OF THE CAKE ON EA,AND <br /> TIN .ON <br /> O <br /> 117106(C)ATE CAKE 9-9:30AM.(C)STARTED FEELING ILL AT 11:30AM AND HAD SEVERE STO2PM.(CMACH PAIN, DIARRHEA,AND VOMITING BY <br /> ON(FOOD <br /> 1 5 AND)6 WERE FROM THE WHOLE AS BACTERIAL CAKE BUT THE PIECEIEATEN ON 1/7 WAS AN ADDITIONALLY <br /> WENT TO ER. EXTRA PIECE PLACED ON TOP OF THE CAKE. <br /> "`(C)REQUESTS CALLBACK AFTER INSPECTION. <br /> Complaint Mode: PGomplaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter <br /> E-Code Enforcement M-Mail i Correspondence O-Other EH Unit _ P-Phone_ <br /> FACILITY INFORMATION `— OWNER INFORMATION <br /> Facility:FA0001709-S-MART#1309 Owner: OW0000369-SAVE MART SUPERMARKETS <br /> Site Location 1616 E MARCH LN RP/DBA <br /> STOCKTON,CA 95207 RPAddress <br /> <br /> <br /> <br /> <br /> <br /> District 002-MARENCO,DARIO Location Code 01 -STOCKTON <br /> APN 096114020 <br /> Data Abated l4-16 6 inspector 6pa/3 <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 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-END 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-FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) Completed <br /> Complaint History <br /> Attached But Not <br /> Scanned <br /> 5104.rpt <br />