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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00042646 Site Location: 4219 E WATERLOO RD AccountlD: AR0002198 <br /> Receivedby: EE0000025 SEDRA Received Date: 12/6/2016 Print Date: 12/6/2016 9:05:10AM <br /> Assigned To: EE0009488 WONG Assigned Date: 12/6/2016 <br /> Procrem/Element Code:1600-FOOD PROGRAM <br /> Complainant: :JAMES TINDELL Home Phone 213-434-4580 <br /> Address : Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES THAT ON 12/6/2016 AT APPROXIMATELY 8:15 AM,THEY WENT TO EAT AT THE COMPLEMENTARY BUFFET AND <br /> OBSERVED 2 COCKROACHES ON THE FOOD.COMPLAINANT DID NOT EAT.PLEASE CALL COMPLAINANT WITH FINDINGS. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> 1-Intemet/Email S-Shenfrs Office <br /> -- -------------- ----------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002187-CLARION INN&SUITES Owner: OW0001699-WATERLOO ENTERPRISES INC <br /> Site Location 4219 E WATERLOO RD RPiDBA CLARION INN&SUITES <br /> STOCKTON,CA 95215 RP Address 4219 E WATERLOO RD <br /> Goss Street HWY 99 STOCKTON,CA 95215 <br /> Mailing Address: 4219 E WATERLOO RD Billing Address 4219 E WATERLOO RD <br /> STOCKTON,CA 95215 STOCKTON,CA 95215 <br /> Home Phone :209-981-8116 <br /> Phone :209-981-8116 Work Phone <br /> District 002-MILLER KA HERINE Location Code <br /> APN 08710009 <br /> Date Abated L - © r � Inspector lD#: <br /> ———————— —— ———————————————— —— ——————— <br /> Send Retemil to Retemal Letter y <br /> Relennal Address �n(} Date: <br /> Complaint Status Code:1 % X <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -Field Response-Violations Cited and Corrected 28-Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-ReBerred to Other Agency <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omplaint Reviewedy: IDote: Updated by: ate: <br /> z- 9-i>b <br /> slog rpt <br />