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Complaint Investigation Form Report#: 5104 <br /> - Account ID: AR0037529 <br /> COMPLAINT ID: C00045338 Site Location: 25456 S SCHULTE RD <br /> Received by: EE0000025 SEDRA <br /> Received Date: 12/29/2017 PrintDate: 12/29/2017 4:58:39PM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 12/29/2017 <br /> Procram/Element Code:1600-FOOD PROGRAM Home Phone : 209-650-8354 <br /> Complainant: :ANGELA RAMIREZ Work Phone <br /> Address <br /> ' -Mail Address <br /> Nature of com taint: <br /> COMPLAINANT ALLEGES ON 12J29/2.1 7 AT APPROXIMATELY 12:30 PM THEY ORDERED A CARNIT SUPER BURRITO TO G <br /> APPROXIMATELY 1 12 HOURS AFTER EATING,COMPLAINANT BECAME ILL WITH SYMPTOMS DIARRHEA.COMPLAINANT ALSO STATED <br /> 1/ <br /> THAT HALF WAY THROUGH THE BURRITO THEY FOUND A PIECE OF WIRE APPROXIMATELY 1 Y2"TO 2"IN LENGTH.PLEASE CALL <br /> COMPLAINANT WITH FINDINGS. <br /> Com taint Mode Cotles A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> Complaint Mode: p P <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet/Email S-Sheriffs Office ------__________— <br /> ——————————————————————————————— <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Owner: OW 0017179-REYNOSO,HUGO ALBERTO <br /> Facility:FA0020888-JALOS TAQUERIA <br /> RP/DBA <br /> Site Location 25456 S SCHULTE RD <br /> RP Address <br /> TRACY,CA 95377 196 CARNATION CIR <br /> VALLECA 94589 <br /> Cross Street MOUNTAIN HOUSE <br /> Mailing Address: 25456 S SCHULTE RD Billing Address A CARNATION <br /> ATION CIR <br /> V <br /> TRACY,CA 95377 LLEJO,CA 94589 <br /> Home Phone :707.333-2175 <br /> Phone :209-830-8066 Work Phone ;209-830-8066 <br /> District 005-ELLIOTT,BOB Location Code 99-UNINCORPORATED AREA <br /> APN 20944035 (� <br /> Date Abated ,- �� 1 v Inspector ID �� <br /> Referral Letter Sent by <br /> Send Referral to Date: <br /> Referral Address <br /> V-t- <br /> Complaint Status Code:-. Zq <br /> Circle appropriate Status Code <br /> 01 -Field Response-Violations Cited and Corrected 50-LEAD Assessment Pedormed-No Abatement Required <br /> 52-LEAD Abatement Regired-See Program Record File <br /> 02-Office Response Only <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Reflerred to Other Agency <br /> MN-EHD Monitoring Status <br /> 08-Unable to Verify Alleged Complaint <br /> PO-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> RS-Resolved-New Well installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> S1 k pumped <br /> 12-DA Referred Complaint-See Program Enforcement Action Form <br /> -Tank u <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hocked <br /> repaired <br /> to public sewer <br /> S3 Septic system <br /> 28-Alleged FBI-No Major Violations Identified <br /> - <br /> 29-Alleged FBI-Major Violations Identified <br /> omp amt Reviewed lby: — <br /> Date. pdate 2-21 <br /> 510G.rpt <br />