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r Y Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00038752 Site Location: 25456 S SCHULTE RD Account ID: AR0037529 <br /> Received by EE0009058 LOWE Received Date: 10/23/2014 Print Date: 10/23/2014 1:40:44PM <br /> Assigned To EE0001420 NISSIM Assigned Date: 10/23/2014 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :JUAN ROSALES Home Phone <br /> Address Work Phone :602-469-8131 <br /> Mail Address <br /> Nature of complaint: <br /> ON 10/17/2014(C)PURCHASED A BREAKFAST BURRITO WITH CHORIZO,CHEESE AND EGG. (C)STATES THERE WAS NO CHORIZO IN THE <br /> BURRITO,BUT CONTAINED EXCESS MEAT DRIPPINGS SCRAPED FROM THE GRILL AND PUT INSIDE WITH EGG AND CHEESE. <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 /> I-Internet/Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0020888-JALOS TAQUERIA Owner: OW0017179-REYNOSO,HUGO ALBERTO <br /> Site Location 25456 S SCHULTE RD RP/DBA : <br /> TRACY,CA 95377 RP Address 196 CARNATION CIR <br /> Cross Street VALLEJO,CA 94589 <br /> Mailing Address: 25456 S SCHULTE RD Billing Address 196 CARNATION CIR <br /> TRACY,CA 95377 VALLEJO,CA 94589 / <br /> Home Phone :707-333-2175 — •5 <br /> Phone :209-830-8066 Work Phone :209-830-8066 <br /> District 005-ELLIOTT,BOB Location Code <br /> APN 20944035 <br /> Date Abated , , 1�1 Inspector ID#.' <br /> Send Referral to I�1 Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: Ll <br /> Circle appropriate Status Code kr <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 /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Regired-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 /> 5104.rpt <br />