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Uvili <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00051172 Site Location: 1120 E HAMMER LN Account ID: AR0001198 <br /> Received by: EE0006213 PEDRAZA Received Date: 11/12/2019 Print Date: 11/12/2019 9:59:57AM <br /> Assigned To: EE0078788 FAHMY Assigned Date: 11/12/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT PURCHASED GO GO GINGER CHICKEN FROM THIS FACILITY ON 11/11/19 AT AROUND 2:50 PM.THE PRODUCT WAS <br /> FROZEN.COMPLAINANT HEATED PRODUCT AT HOME AND FOUND SOMETHING SHE BELIEVES TO BE WORMS IN THE PRODUCT, <br /> Complaint Mode: C Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> -------------------------------------------- - -- - - -- <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0001200-99 Cents Only Stores#177 RP DBA <br /> Site Location 1120 E Hammer Ln RP mailing address <br /> Stockton,CA 95210 <br /> Cross Street KATHLEEN <br /> Mailing address 4000 Union Pacific Avenue RP contact <br /> Commerce,CA 90023 RP contact phone <br /> Phone 209-956-4992 EXT: <br /> Owner: OW0010964-99 Cents Only Stores <br /> DBA <br /> Owner address 4000 UNION PACIFIC AVE <br /> COMMERCE,CA 90023 <br /> Billing Address 4000 Union Pacific Avenue <br /> Commerce,CA 90023 <br /> Home Phone 323-980-8145 <br /> Work Phone 323-980-8145 EXT: <br /> District 002-MILLER,KATHERINE Location Code 01-STOCKTON <br /> APN 09403043 <br /> Date Abated `� I Inspector ID#: '?j1 3 <br /> ------------ ------------------------- ------ -- -- - --- - <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: r ► 7� <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 Regired-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 /> omplaint Reviewed by:(- ate: Updated by: Da <br /> 5104.rpt <br />