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` Complaint Investigation Form Report#: 5104 I <br /> COMPLAINT ID: C00051173 Site Location: 2355 W GRANT LINE RD Account ID: AR0020776 <br /> Received by: EE0009830 SAUERS Received Date: 11/12/2019 Print Date: 11/12/2019 1:23:36PM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 11/12/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> FACILITY ALLEGEDLY HAS ROACHES. <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 O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> ---------------------------------------------- - - - <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0012586-BOTTOMS UP ESPRESSO RP DBA <br /> Site Location 2355 W GRANT LINE RD RP mailing address <br /> TRACY,CA 95377-7308 <br /> Cross Street <br /> Mailing address 4 W WA I LKN I ONE DR RP contact <br /> ROSEVILLE,CA 95747 RP contact phone <br /> Phone 209-833-9933 <br /> Owner: OW0009786-PATEL,SPANDAN <br /> DBA BOTTOMS UP ESPRESSO <br /> Owner address 4721 WATERSTONE DR <br /> ROSEVILLE,CA 95747 <br /> Billing Address 4721 WATERSTONE DR <br /> ROSEVILLE,CA 95747 <br /> Home Phone 916-474-4184 <br /> Work Phone 916-257-5156 <br /> District 005-ELLIOTT,BOB Location Code 03-TRACY <br /> APN 21402033 <br /> Date Abated ( �— 4 G Inspector ID#: U\ <br /> 1 O\I e <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 012) <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 Reviewed by: ��r. t ( Date: pdate y: a ;� e <br /> 5104.rpt t l <br />