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V <br /> Complaint Investigation Form Report#:5104 <br /> I <br /> COMPLANT ID: CO <br /> � - 0036276 Site Location: 2072 W YOSEMITE AVE Account ID: <br /> f. <br /> { Received by: EE0009649 ESTRADA Received Date: 4/15/2013 Print Date: 4/15/2013 4:06 32FM <br /> Assigned To: EE0003474 OM Assigned Date: 4/15/2013 <br /> Program Seent Code,-1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> 4114/13 PURCHASED AN ORANGE JUICE FREEZE DRINK FROM A STREET VENDOR WITH A PUSH CART LOCATED AT THE CORNER OF <br /> YOSEMITE&AIRPORT WAY(PARKING LOT OF GAS STATION)SHE EXPERIENCED NAUSEA,DIARRHEA,AND DIZZY SPELLS-LATER THAT <br /> SAME EVENING <br /> Complaint Mode: p Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> r <br /> ____ I-Intemet I Email S-Sheriffs Office I <br /> PROPERTY INFORMATION — PROPERTY OWNER INFORMATION — — <br /> Property Name: Responsible Party or Property Owner:UNKNOWN <br /> Site Locafion 2072 W YOSEMITE RPIDBA <br /> MANTECA,CA 95337 RP Address •_ <br /> Cross Street <br /> ". Billing Address , <br /> a <br /> Home Phone <br /> Phone Work Phone <br /> 1 District 005-ORNELLAS,LEROY Location Code 04-MANTECA <br /> APN 22202001 <br /> Date Abated i+_ ) -7 — Inspector lD#: <br /> ——— ———— ———— ___ ___ <br /> -------- — .=----------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Is <br /> E <br /> Comptafnt Status Code: <br /> I <br /> Circle appropriate Status Code <br /> 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 /> .i <br /> 03-NAI SENT,I 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 /> r <br /> 06-EH FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> E .k <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> OB UNABLE TO VERIFY CL-Case Closed <br /> i <br /> s <br /> 10-POSTED SU. BSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> F5104.rp1 `Iy- <br />