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` Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00044058 Site Location: 3021 REYNOLDS RANCH PKWY Account ID: AR0034531 <br /> Received by: EE0000467 CARRUESCO Received Date: 8/23/2017 Print Date: 8/23/2017 4:45:47PM <br /> Assigned To: EE0009488 WONG Assigned Date: 8/23/2017 <br /> Prooram/Element Code <br /> <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES THEY FOUND A WORM IN SALAD ON 8/21/2017.COMPLAINANT STATES THE WORM WAS ABOUT 3 INCHES IN <br /> LENGTH. <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 /> l4ntemet/Email S-Sheriffs Office <br /> ---------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0019418-BLUE SHIELD OF CALIFORNIA Owner: OW0015914-BLUE SHIELD OF CALIFORNIA <br /> Site Location 3021 REYNOLDS RANCH PKWY RP/DBA BLUE SHIELD OF CALIFORNIA <br /> LODI,CA 95240 RP Address 4203 TOWN CENTER BLVD <br /> Cross Street 99 FRONTAGE ELDORADO HILLS,CA 95672 <br /> Mailing Address: 3021 REYNOLDS RANCH PKWY Billing Address 3021 Reynolds Ranch Pkwy <br /> LODI,CA 95240 Lodi,CA 95240 <br /> Home Phone :916-350-7794 <br /> Phone :209.371-3822 EXT: Work Phone :209-371-3822 EXT: <br /> District 004-WiNN,CHICES Location Code 02-LOD <br /> APN 05865 <br /> Date Abated Inspector ID#: <br /> --------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Cod <br /> { <br /> Circle appropriate Status Code e <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Pedormed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> 0 -Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> efferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08- <br /> nable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 0-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form St-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> _plaint Reviewed by: Date Up ate y: <br /> 5104.rpt <br />