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vj <br /> ♦ Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00049675 Site Location: 5350 PACIFIC AVE STE J1 Account ID: AR0025916 <br /> Received by: EE0009830 SAUERS Received Date: 4/22/2019 Print Date: 4/22/2019 9:13:32AM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 4/22/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT CONSUMED SHRIMP FROM THIS FACILITY THE WEEK OF 4/15/19 AND ALLEGES UPON FINISHING HER MEAL,HER <br /> STOMACH BEGAN TO"BOIL",SHE HAD GAS AND GOT DIARRHEA. <br /> PLEASE CALL COMPLAINANT WITH FINDINGS <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 0-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> --------------------------------------------------- <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0015113-PANDA EXPRESS#887 RP DBA <br /> Site Location 5350 PACIFIC AVE STE J l RP mailing address <br /> STOCKTON,CA 95207 <br /> Cross Street <br /> Mailing address Panda Restaurant Group,Attn:Risk Dept,1683 Wain RP contact <br /> Rosemead,CA 91770 RP contact phone <br /> Phone 209-476-1908 EXT: <br /> Owner: OW0011593-Panda Restaurant Group,Inc. <br /> DBA PANDA EXPRESS <br /> Owner address 1683 WALNUT GROVE AVE <br /> ROSEMEAD,CA 91770 <br /> Billing Address 1683 Walnut Grove Avenue <br /> Rosemead,CA 91770 <br /> Home Phone 626-799-2331 <br /> Work Phone 626-799-9898 EXT: <br /> District 002-MILLER,KATHERINE Location Code 01-STOCKTON <br /> APN 10224014 / /_ <br /> Date Abated I —l� Inspector ID#: F L o h rs G h u 7L <br /> Z <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 SUBSTANDARD/UNSECURED-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 /> omp aint Reviewedy: r ` ate: pate y: a L� <br /> 5104.rpt <br />