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` Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00034997 Site Location: 2072 YOSEMITE AVE Account ID. AR0004954 <br /> Received by: EE0002670 NAIDU Received Date: 512212012 Print Date: 5/22/2012 9:14:36AM <br /> Assigned To: EE0003474 OM Assigned Date: 5122/2012 <br /> E8Lwm1F_1ement Code 1600-FOOD PROGRAM <br /> Complainant: ; <br /> <br /> <br /> Nature of complalLj&j r 1 �b <br /> BOUGHT4feT-PGQKC-+FROM STORE AND WARMED IT UP.WHILE EATING NOTICED IT WAS GREEN INSIDE. <br /> `*ASKED FOR A CALL BACK( " <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 1 Correspondence O-Other EH Unit P-Phone <br /> 1-Intemet l Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0004625-QUICK SHOP Owner: OW0003558-CHAHOUD,PIERRE TONY <br /> Site Location 2072 W YOSEMITE AVE RP/DBA : <br /> MANTECA,CA 95337 RP Address 2244 RYANLEE DR <br /> Cross Street YOSEMITE RIVERBANK CA 95367 <br /> Mailing Address: 2072 W YOSEMITE AVE Billing Address 2244 RYANLEE DR <br /> MANTECA,CA 95337 RIVERBANK CA 95367 <br /> Nome Phone :320-3454689 EXT: CELL <br /> Phone :209.824.6700 Work Phone :209-823-3300 <br /> District Location Code <br /> APN <br /> Date abated s- Inspector 0#: <br /> Send Referral to I Y' Referraletter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:/9(_ <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODSORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 28-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 Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 87-Disaster Planning and Response <br /> O6-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 SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104.rpi <br />