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&r— Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: CO0014614 Site Location: 5308 PACIFIC AVE 8 Account ID: AR0002462 <br /> Receivedby: EE0006519 DISA Received Date: 8/7/2000 <br /> Assigned To: EE0009157 BARCELLOS Assigned Date: 8/7/00 <br /> Program/Element Code: 1614-FOOD EST>1001 SQ FT W/O SEATING <br /> Complainant., <br /> <br /> Nature of complaint: <br /> PHYLLIS AND HER DAUGHTER ATE A BURRITOS FOR LUNCH ABOUT 1 PM 08-05-00 ABOUT 2 PM PHYLLIS BECAME ILL LATER THAT <br /> DAY HER DAUGHTER ALSO BECAME ILL DIARRHEA. <br /> Complaint Mode P Complaint Mode Codes A-Agency Refern B-Bd of Supervisors/City C-Count( E-Code Enforoeme <br /> M-Mail/Correspond( O-Other EH Unit P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0002901 -OLDE TYME BURRITOS OW0002167-FERRARI,LISA <br /> Site Location: 5308 PACIFIC AVE#8 <br /> STOCKTON,CA 95207 RPAddress: 6808 HAIGHT RD <br /> Mailing Addmss: 5308 PACIFIC AVE#8 <br /> STOCKTON,CA 95207 Billing Address: 6808 HAIGHT RD <br /> Phone: 1st: 209-951-3822 LODI,CA 95240 <br /> Phone: <br /> Wk: <br /> District: Location Code: 01 -STOCKTON <br /> APN: <br /> Date Abated: /O Ili <br /> Inspector (r�»�T <br /> Send Referral to: <br /> Referral Letter Sent by: <br /> Referral Address: U Date: <br /> Complaint Status Code: O <br /> 01 -Field Abated 10-Substandard Property-See HOUSING ABATEMENT 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 Initialed 50-Lead Hazard Evaluation Required(1) <br /> 06-EHD Permit Facility-See Linked Premise File 52-Lead Hazard Abatement in Progress(3) <br /> Referred To Other Agency 53- Lead Hazard Visual Inspect Satisfactory (4) <br /> OS Invalid/Unable To Verify 51 - Lead Hazard Work Plan Submitted(2) <br /> - Foodborne Illness 54- Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55- Lead Hazard Monitoring Schedule (6) <br /> 12- Enforcement Case-Transferred To LIQUID WASTE File 56- Lead Hazard Abatement Complete (7) <br /> 13- Enforcement Case-Transferred To SOLID WASTE File 57- Lead Hazard Property Vacant W/Soil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58- Lead Hazard Case-See Active File For This Site <br /> 0104.rpt <br />