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+V� Complaint Investigation Form Report#: 5144 <br />� t ' <br /> COMPLAINT ID: 000036841 Site Location: 3900 WEST LN' AccountlD: AR4004613 <br /> Received by: EE0090753 MARTINEZ Received Date: 8/20/2013 Print Date: 8/20/2013 10:0011AM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 8/20/2013 <br /> Progrram/Element Code:1604-FOOD PROGRAM <br /> Complainant: ; <br /> <br /> <br /> Nature of complaint: <br /> ON 8114 @ 12:30(C)ORDERED A TUNA SANDWICH&HER HUSBAND ORDERED A SALAD WITH BLUE CHEESE DRESSING.BOTH WI=RE NOT <br /> GOLD(ROOM TEMPERATURE).NO ONE GOT SICK <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors t City Council C-Counter F-Fax <br /> E-Cade Enforcement M-Mail l Correspondence O-Other EH Unit P-Phone <br /> I-Internet I Email S-Sheriffs Office <br /> --- ------ ----. --- — __— <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002383-WEST LANE BOWL Owner: OW0001829-WEST LANE BOWL INC <br /> Site Location 3900 WEST LN RP/DBA WEST LANE BOWL <br /> STOCKTON,CA 95204 RP Address 3900 WEST LN <br /> Cross Street WEST STOCKTON,CA 95204 <br /> Mailing Address: 3900 N WEST LN Billing Address 3900 N WEST LN <br /> I STOCKTON,CA 95204 STOCKTON,CA 95204 <br /> Home Phone <br /> Phone :209-466-3317 EXT: 0 Work Phone <br /> District Location Code <br /> APN /� _ <br /> Date Abated "f j �3 Inspector ID#: <br /> Send Referral to f Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> i 12-DA Referred Complaint-See Violation Tracking Form <br /> + 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02.OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE.TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br /> 0 EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99_UNSPECIFIED-Old Complaint-No Original Found. <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> i <br /> 10-POSTED SUBSTANDARDlUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> i <br /> 5104.rp1 <br />