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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00045084 Site Location: 2211 N WILSON WAY Account ID: <br /> Receivedby: EE0000035 HERNANDEZ Received Date: 6/13/1991 Print Date: 11/9/2017 9:41:54AM <br /> Assigned To: EE0000753 NG Assigned Date: 11/9/2017 <br /> ProuramiElement Code:1600-FOOD PROGRAM <br /> Complainant: :GOLDIE HOLSTE Home Phone : 209464-5297 <br /> Address :2315 HACKBERRY Work Phone <br /> E-Mail Address <br /> Nature of complaint: <br /> COMPLAINT WAS FOUND AND ALLEGES"ON 6/11/91 AT 12:30PM ATE TURKEY SANDWICH AND DRANK CHERRY COKE.NOTICED BLOOD IN <br /> THE TURKEY MEAT(REMOVED IT)AND THE SANDWICH WAS WARM.AT 1:30PM STARTED WITH DIARRHEAAND STOMACH CRAMPS.ON <br /> 6/13/91 AT 12:30 GOLDIE AND GRANDSON MATHEW 13 YRS OLD ATE SAME MEAL 6/11/91,THIS TIME SANDWICH WAS COLD AND HAD <br /> BLOOD IN THE MEAT(REMOVED IT).AT 1:30PM STARTED DIARRHEATHIS TIME WAS NOT SEVERE"ORIGINAL COMPLAINT#910890 ON <br /> 6/13/91.(GIVEN ENVISION COMPLAINT NUMBER TO HAVE IN DATA BASE FOR FUTURE REFERENCE) <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 /> 1-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner:FAR EAST CAFE <br /> Site Location 2211 N WILSON RP/DBA FAR EAST CAFE <br /> STOCKTON,CA 95205 RPAddress <br /> Cross Street <br /> Billing Address <br /> Home Phone 209-463-44/8 <br /> Phone Work Phone <br /> District 002-MILLER,KATHERINE Location Code 01-STOCKTON <br /> APN 11707050 <br /> Date Abated (P • , •—/,r 1 1 Inspector ID#: N <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: n„ <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 Reqired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 0Relferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> -08 Unable to Verity Alleged Complaint MN-EHD Monitoring Status <br /> 0-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEEACTIVE 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 S$-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> ompaint Reviewed y: ate:�01 �q 1 pate y: ate2 <br /> 5104.rpt <br />