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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00051319 Site Location: 7707 AUSTIN RD Account ID: AR0040095 <br /> Received by: EE0000467 CARRUESCO Received Date: 12/6/2019 Print Date: 12/6/2019 11:17:15AM <br /> Assigned To: EE0000467 CARRUESCO Assigned Date: 12/6/2019 <br /> Prooram/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> E-Mail Address <br /> Nature of com /aint: <br /> THERE IS AVENDOR AT THE ABOVE FACILITY THAT IS SELLING RE-PACKAGED POTENTIALLY HAZARDOUS FOOD OR HOMEMADE <br /> POTENTIALLY HAZARDOUS FOOD FROM A VENDING MACHINE ON SITE. FOOD IS SPOILED AND COMPLAINANT GOT SICK FROM IT. <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:FA0021992-CDCR-California Health Care Facility RP DBA <br /> Site Location 7707 Austin Rd RP mailing address <br /> Stockton,CA 95215 <br /> Cross Street NEWCASTLE <br /> Mailing address 7707 Austin Road RP contact <br /> Stockton,CA 95215 RP contact phone <br /> Phone 209-467-2500 EXT: <br /> Owner: OW0018106-State of California CDCR <br /> DBA <br /> O-eraddress 9838 OLD PLACERVILLE RD STE B <br /> SACRAMENTO,CA 95827 <br /> Billing Address 7707 Austin Road <br /> Stockton,CA 95215 <br /> Home Phone 916-255-3838 <br /> Work Phone 209-467-2500 EXT: <br /> District 001 -VILLAPUDUA,MIGUEL Location Code 99-UNINCORPORATED AREA <br /> APN 181-100-11 <br /> Date Abated . 1 �J I Inspector ID#: 6-2,13 <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 /> omp amt Reviewed by: i r ate: Updated by:f <br /> �. ate:.` <br /> 5104.rpt l� <br />