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Vj <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00052312 Site Location: 1950 W ELEVENTH ST Account ID: AR0002542 <br /> Received by: EE0009830 SAUERS Received Date: 7/22/2020 Print Date: 7/22/2020 12:24:011'M <br /> Assigned To: EE0004589 LINHARES Assigned Date: 7/22/2020 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> E-Mail Address <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES THE BAUDUCCO BRAND SHORTBREAD COOKIES THEY PURCHASED AT THIS FACILITY SMELLAND TASTE <br /> STRONGLY OF PAINT AND CHEMICALS.COMPLAINANT STILL HAS PACK OF COOKIES. <br /> —PLEASE CALL COMPLAINANT <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:FA0002980-FOOD MAXX#490 RP DBA <br /> Site Location 1950 W ELEVENTH ST RP mailing address <br /> TRACY,CA 95376 <br /> Cross Street CORRAL HOLLOW <br /> Mailing address 1800 Standiford Ave. RP contact <br /> Modesto,CA 95352-466 RP contact phone <br /> Phone 209-832-3867 EXT: <br /> Owner: OW0000369-SAVE MART SUPERMARKETS <br /> DBA <br /> Owner address 1800 STANDIFORD AVE <br /> MODESTO,CA 95350 <br /> Billing Address 1800 STANDIFORD AVE <br /> MODESTO,CA 95350 <br /> Home Phone 209-574-6299 EXT: 111 <br /> Work Phone 209-577-1600 EXT: <br /> District 005-ELLIOTT,BOB Location Code 03-TRACY <br /> APN 234-020-100-000 <br /> Date Abated _7— Z$- 240 Inspector ID#: hA t C <br /> --------------------------------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: Ol <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 <br /> J <br /> Z_ ate: Dafe¢Y / <br /> 5104.rpt 1 1 <br />