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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00051226 Site Location: 575 W CLOVER RD Account ID: AR0008870 <br /> Received by: EE0009848 MARTINEZ Received Date: 11/18/2019 Print Date: 11/20/2019 1:17:27PM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 11/20/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT HAD LUNCH AT INN OUT AND BECAME ILL AFTER EATING.WAS VOMITING AND HAD DIARRHEA.COMPLAINANT CALLED <br /> RESTAURANT TO COMPLAIN AS WELL. <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:FA0006595-IN N OUT BURGER#96 RP DBA <br /> Site Location 575 W CLOVER RD RP mailing address <br /> TRACY,CA 95376 <br /> Cross Street TRACY <br /> Mailing address 4199 CAMPUS DR 9TH FLOOR RP contact <br /> IRVINE,CA 92612 RP contact phone <br /> Phone 949-509-6200 EXT: <br /> Owner: OW0005335-IN N OUT BURGER INC <br /> DBA <br /> Owner address 13502 HAMBURGER LN <br /> BALDWIN PARK,CA 91706 <br /> Billing Address 4199 CAMPUS DR 9TH FLOOR <br /> IRVINE,CA 91706 <br /> Home Phone 626-813-8200 <br /> Work Phone 949-509-6300 EXT: <br /> District 005-ELLIOTT,BOB Location Code 03-TRACY <br /> APN 21421006 <br /> Date Abated � ' _2 Z — ' q Inspector ID#: <br /> ------------------------------------------------- <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 /> ompamt eviewe y: ate: pate y:Y <br /> 5 - <br /> 5104.rpt <br />