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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00039576 Site Location: 20801 S WOODWARD AVE Account lD. AR0001050 <br /> Received by: EE0004589 LINHARES Received Date: 4/22/2015 Print Date: 4/22/2015 4:25:48PM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 4/22/2015 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant ANONYMOUS Home Phone <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> FACILITY INSTALLED OUTDOOR KITCHEN IN A SHED. NO PERMITS OBTAINED. <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 /> I-Intemet/Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0001052-ISLANDER TAVERN Owner: OW0005077-HOGAN,RICHARD J <br /> Site Location 20801 S WOODWARD AVE RP/DBA <br /> MANTECA,CA 95336 RP Address 1691 FREWERT RD SPC 4 <br /> Cross Street WILLIAMSON LATHROP,CA 95330--978 <br /> Mailing Address: 20801 S WOODWARD AVE Billing Address 1691 FREWERT RD SPC 4 <br /> MANTECA,CA 95336 LATHROP,CA 95330--978 <br /> Home Phone :702-321-6115 <br /> Phone :209-823-6019 Work Phone ;209-983-0643 EXT: BAR <br /> District 005-ELLIOTT,BOB Location Code 99-UNINCORPORATED AREA <br /> APN 24125033 <br /> Date Abated S— b l 5 Inspector ID#: Un <br /> `- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code v <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Regired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104 rpt <br />