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Complaint Investigation Form <br /> Report#:5104 <br /> COMPLAINT ID: C00045959 Site Location: 4219 E WATERLOO RD Account ID: AR0002198 <br /> Received by: EE0000014 MORENO Received Date: 3/13/2018 Print Date: 3/132018 2:12:25PM <br /> Assigned To: EE0078788 FAHMY Assigned Date: 3/13/2018 <br /> Pmomm / ment Code:1600-FOOD PROGRAM <br /> Complainant: :SITYANN COOK Home Phone 209-398-9696 <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> BLACK MOLD INSIDE KITCHEN SINKAREA.FRIDGE AND FREEZERAREA DIRTYAND MOLDY IMPROPER PACKAGING. <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 /> -----------------------—------_-------------- <br /> I-Intemet/Email S-Sheriffs Once <br /> ------------------------_--------------_-------------------------------------------------------_---------------------------------- <br /> PROPERTY INFORMATION <br /> 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 RPAddress 4219 E WATERLOO RD <br /> Cress Street HWY 99 STOCKTON,CA 95215 <br /> Mailing Address: 4219 E WATERLOO RD Bfiling 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 004-WINN,CHARLES Location Code 99_UNINCORPORATED AREA <br /> APN 08710009 <br /> Date Abated 03{ Inspector ID#: <br /> �J <br /> Send Referral to Referral Letter Sent by <br /> Referral Address <br /> Date: <br /> Complaint Status Code: O/ <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-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 S1-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 /> omplaint Reviewedy: _ , 7[ I ate. pdated y. <br /> 5104.rpt <br />