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F � t <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00025671 Site Location: 1616 E MARCH LN Account ID: AR0001708 <br /> Received by: EE0007541 FIELD Received Date: 1/5/2007 Print Date <br /> 1/5/2007 8:54:59AM <br /> Assigned To: EE0006213 PEDRAZA Assigned Date: 1/5/2007 <br /> ProgramlElernent Code'1600-FOOD PROGRAM <br /> Complainant: :BECKY WIMARK MORTON Nome Phone 209-465-246 ��� 1 F tur1D� <br /> Address Work Phone <br /> Nature of corn taint: <br /> ON 12/31/06 AROUND 1 PM, (C)PURCHASED CHOW MEIN AND PORK FROM THE CHINESE DELI. (C)ATE AT HOME ABOUT 112 HOUR LATER. <br /> ABOUT 1 HOUR LATER, (C)BECAME ILL WITH DIARRHEA AND VOMITING THAT LASTED THROUGH THE EVENING ON 114107. (C)WENT TO <br /> DR. ORDEN(KAISER)ON 114107 AND WAS GIVEN AN IV FOR DEHYDRATION,A SHOT OF PHENERGAN,AND WAS SENT HOME WITH <br /> PHENERGAN AND LOMOTIL. -(C)REQUESTS CALL BACK AFTER INSPECTION FROM INSPECTOR.— <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors t City Council C-Counter <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> -- ------------------------------------------ <br /> FACILITY <br /> ---- ------ ----- ----- ------ - ---- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0001709-S-MART#309 Owner: OW0000369-SAVE MART SUPERMARKETS <br /> Site Location 1616 E MARCH LN RP/DBA <br /> STOCKTON,CA 95207 RP Address <br /> <br /> <br /> <br /> <br /> <br /> District 002-MARENCO,DARIO Location Code 01 -STOCKTON <br /> APN 09614020 <br /> Date Abated 7 Inspector. j <br /> Send Referral to / Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code., Z& <br /> Circle appropriate Status Code <br /> of-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-EHD 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 U{C PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed i No Major Violations <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations Identified <br /> lo,SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint <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 /> COT_?rlall:t i).1SLL' r <br /> Attached But Not <br /> Scanned <br /> 5104.rpt <br />