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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00048949 Site Location. 5420 PACIFIC AVE Account ID AR0024926 <br /> Received by: EE0000467 CARRUESCO Received Date: 2/22/2019 <br /> <br /> <br /> <br /> ddress Work Phone <br /> E-Mail Address glazinginla@gmail.com <br /> Nature of complaint: <br /> COMPLAINANT DINED AT THIS FACILITY ON 2/11/2019.COMPLAINANT CONSUMED A LARGE PIECE OF CHICKEN PARMESAN,A SIDE SALAD <br /> AND BREAD WITH OLIVE OIL.COMPLAINANT ALLEGES THEY HAVE A SEVERE CASE OF A GASTROINTESTINAL VIRUS.COMPLAINANT <br /> ALLEGES THEY ARE STILL SICK AS OF TODAY,2/22/2019. <br /> Complaint Mode: I Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence 0-Other EH Unit P-Phone <br /> I-Intemet/Email S-Sheriffs Office <br /> -------------------------------------- ----------- <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0014657-ROMANOS MACARONI GRILL RP DBA <br /> Site Location 5420 PACIFIC AVE RP mailing address <br /> STOCKTON,CA 95207 <br /> Cross Street PACIFIC <br /> Mailing address 1855 BLAKE ST STE 200 RP contact <br /> DENVER,CO 80202-428 RP contact phone <br /> Phone 209-951-7064 EXT: <br /> Owner: OW0015906-MAC ACQUISITION LLC <br /> DBA <br /> Owner address 6750 LBJ FREEWAY <br /> DALLAS,TX 75240 <br /> Billing Address 3100 S GESSNER SUITE 125 <br /> HOUSTON,TX 77063 <br /> Home Phone 866-997-4777 <br /> Work Phone 832-649-2260 EXT: <br /> District 002-MILLER,KATHERINE Location Code 01-STOCKTON <br /> APN 10224023 n <br /> Date Abated ;L- �j-I Inspector/D#: F[oh YSckAk-f-z- <br /> --------------------------------------------------- <br /> Send <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 29 Alleged FBI-Major Violations Identified <br /> 02-Office Response Only 50-LEAD Assessment Performed-No Abatement Required <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 52-LEAD Abatement Reqired-See Program Record File <br /> 07-Referred to Other Agency 97-Disaster Planning and Response <br /> 08-Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 10-POSTED SUBSTANDARDWNSECURED-See Housing File MN-EHD Monitoring Status <br /> 11-Multiple Complaints-SEE ACTIVE CASE# PD-Permit Issued-Pending Well Installation <br /> 12-DA Referred Complaint-See Program Enforcement Action Form RS-Resolved-New Well Installed <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 28 Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> ompaint Reviewed by: 6i ( ate: Updated by: uaten <br /> 5104.rpt 10 <br />