Laserfiche WebLink
i <br /> Complaint Investigation Form <br /> ., Report#:5104 <br /> CO ,r LAINT ID: CO 035720 Site Location: 25456 S SCHULTE RD Account ID: AR0037529 <br /> Received by: EE0009649 ESTRADA Received Date: 11/28/2012 Print Date: 11/28/2012 2:25:OOPM <br /> Assigned To: EE0001420 NISSIM Assigned Date: 11/28/2012 <br /> j <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: :ANON Nome Phone <br /> Address Work Phone ' <br /> ! -Mail Address <br /> Nature ofcomplaint: <br /> ON 11/28/12 PURCHASED A CHICKEN BURRITO AND A SODA,SAT DOWN TO EAT AND FOUND ANTS CRAWLING ON THE BURRITO AND <br /> INSIDE THE SODA <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors f City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> ]-Internet 1 Email S-Sheriffs Office <br /> r FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0020888-JALOS TAQUERIA Owner: OWOO17179-RODRIGUEZ,ANTONIO <br /> Site Location 25456 S SCHULTE RD RP/DBA JALOS TAQUERIA <br /> TRACY,CA 95377 RP Address 2853 CAMPBELL LN <br /> Cross Street TRACY,CA 95377 <br /> Mailing Address: 25456 S SCHULTE RD Billing Address 2853 CAMPBELL LN <br /> TRACY,CA 95377 TRACY,CA 95377 <br /> Nome Phone :510-750-4380 EXT: CELL <br /> Phone :209-830-8066 Worts Phone :209-830-8066 <br /> District Location Code _ <br /> APN 2094403) <br /> Date Abated , ,,'Z Inspector 1D#: &,L-� X�� <br /> ^� <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coda: <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE=CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> i 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> l ' <br /> 5104.rp1 <br />