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Report#:5104 <br /> Complaint Investigation Form <br /> Account 1D: AR0004954 <br /> COMPLAINT ID: C00023255 Site Location: 2072 W YOSEMITE AVE <br /> Received by: EE0006519 DISA <br /> Received Date: 812512005 Print Date: 8/25/2005 3:5b�.14PM <br /> Assigned To: EE0007380 SH1H Assigned Date: 8/25/2005 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> <br /> <br /> Address <br /> <br /> )BOUGHT EGG ROLL AND ANOTHER ITEM AT FACILITY AND ATE IT ABOUT 12:40, AT ABOUT <br /> 12:45 BECAME ILL WITH CRAMPS,VOMITING, DIARRHEA. <br /> Complaint Mode: PEComplaint Made Codes A-Agency Referral B-Bd of Supervisors I city Council C-Counter <br /> E-Code Enforcement M-Mail l Correspondence O-Other EH Unit '_ P-Phone <br /> f , <br /> FACILITY INFORMATION J �~ J OWNER INFORMATION <br /> Facility:FA0004625-FRANKS ONE/STOP FOOD MART Owner. OW0009507-KIM,IN SOP&MYOUNG OK <br /> Site Location 2072 W YOSEMITE AVE RP/DBA FRANK'S ONE-STOP <br /> MANTECA,CA 95337 RP Address 2072 W YOSEMITE AVE f <br /> MANTECA,CA 95337-9604 <br /> Mailing Address: 2072 W YOSEMITE AVE Billing Address 2072 W YOSEMITE AVE <br /> MANTECA,CA 95337 MANTECA,CA 95337 <br /> Home Phone <br /> Phone :209-239-9575 Work Phone <br /> District 005-ORNELLAS,LEROY Location Code 04-MANTECA SCANNED <br /> APN 222020 1 x�� `r�lT <br /> Date Abated '� ur inspector.- -3 <br /> T Send Referral to Referral Letter Sent by <br /> Referraf Address Date: <br /> Complaint History <br /> Complaint Status Code: 2� Attached But Not, <br /> Scanned <br /> Circle appropriate Status 2d <br /> 01-FIELD ABATED t 14-ENFORCEMENT CASE,Transferred to ER FILE <br /> 02-OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT 16-LETTER SENT TO TENANT <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20--ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY <@ <br /> -1FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# 51 -LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE,Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> 5104rpt <br /> i , <br />