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District 002 - MILLER, KATHERINE <br />Inspector ID #: Date Abated <br />APN 09403I 43 <br />Location Code 01 - STOCKTON <br />4 7:omplaint Reviewed byf — ot I .D.Q Date <br />5104. rpt <br />ukAJ <br />Complaint Investigation Form <br />Report #. 5104 <br />COMPLAINT ID: C00051686 Site Location: 1120 E HAMMER LN <br /> <br />Account ID: AR0001198 <br /> <br />Received by: EE0009848 MARTINEZ <br />Assigned To: EE0078788 FAHMY <br />Program/Element Code 1600 - FOOD PROGRAM <br />Complainant: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />COMPLAINANT PURCHASED A BOX OF JIFFY APPLE CINNAMON PANCAKE MIX ON 01/21/20 FROM THE 99 CENT STORE AND FOUND BUGS <br />IN THE MIX AFTER CONSUMING. COMPLAINANT FILED AN INCIDENT REPORT WITH JIFFY AND THE 99 CENT STORE. COMPLAINANT HAS <br />PICTURES AND VIDEO FOR THE INSPECTOR AND IS REQUESTING A CALL BACK. <br />Complaint Mode: p Complaint Mode Codes A-Agency Referral <br />E-Code Enforcement <br />I-Internet / Email <br />B-Bd of Supervisors / City Council <br />M-Mail / Correspondence 0-Other EH Unit <br />S-Sheriffs Office <br />C-Counter <br />P-Phone <br />F-Fax <br />PROPERTY INFORMATION <br />Facility: FA0001200 -99 Cents Only Stores #177 <br />Site Location 1120 E Hammer Ln <br />Stockton, CA 95210 <br />Cross Street KATHLEEN <br />Mailing address 4000 Union Pacific Avenue <br />Commerce, CA 90023 <br />Phone 209-956-4992 EXT: <br />Owner: 0W0010964 -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 />RESPONSIBLE PARTY INFORMATION <br />RP DBA <br />RP mailing address <br />RP contact <br />RP contact phone <br />Send Referral to <br />Referral Address <br /> <br />Referral Letter Sent by <br />Date: <br /> <br />Complaint Status Code: 6 <br />Circle appropriate Status Code <br />01 - Field Response-Violations Cited and Corrected <br />02 - Office Response Only <br />06 - Violations Cited - see Linked PROGRAM FACILITY FILE <br />0 - Referred to Other Agency <br />8 able to Verify Alleged Complaint <br />10- POSTED SUBSTANDARD/UNSECURED - See Housing File <br />11 - Multiple Complaints - SEE ACTIVE CASE # <br />12 - DA Referred Complaint-See Program Enforcement Action Form <br />15 - ACTIVE HOUSING CASE - NEW COMPLAINT see ACTIVE CASE # <br />28 - Alleged FBI - No Major Violations Identified <br />29 - Alleged FBI - Major Violations Identified <br />50 - LEAD Assessment Performed-No Abatement Required <br />52 - LEAD Abatement Reqired-See Program Record File <br />97 - Disaster Planning and Response <br />99- UNSPECIFIED-Old Complaint-No Original Found <br />MN - EHD Monitoring Status <br />PD - Permit Issued-Pending Well Installation <br />RS - Resolved - New Well Installed <br />Si - Tank pumped <br />S2 - Hooked up to public sewer <br />Updated by: G:\ mosk.—\ y\z_z_ Date: 5\ \ 0 \ 24)