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Complaint Investigation Form Report#:5104 <br /> r <br /> COMPrLAINT ID: C00052473 Site Location: 340 E GRANT LINE RD Account ID: AR0006573 <br /> Received by: EE0000467 CARRUESCO Received Date: 8/18/2020 Print Date: 8/18/2020 8:54:57AM <br /> Assigned To: EE0004589 LINHARES Assigned Date: 8/18/2020 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT PURCHASED CHICKEN LEGS FROM THIS FACILITY ATAROUND 7:30PM ON 8/17/2020.COMPLAINANT ALLEGES THAT WHEN <br /> THEY OPENED THE CHICKEN LEGS,THEY NOTICED THEY WERE GREEN IN COLOR AND THEY WERE MOLDY. <br /> Complaint Mode: I 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:FA0005789-JUANITA MARKET#4 RP DBA <br /> Site Location 340 W GRANT LINE RD RP mailing address <br /> TRACY,CA 95376 <br /> Cross Street GRANT LINE <br /> Mailing address 340 W GRANT LINE RD RP contact <br /> TRACY,CA 95376 RP contact phone <br /> Phone 209-833-0407 <br /> Owner: OW0004600-VALMED INC <br /> DBA JUANITA MARKET#4 <br /> Owner address 2800 SHINN CT <br /> WOODLAND,CA 95776 <br /> Billing Address 2800 SHINN CT <br /> WOODLAND,CA 95776 <br /> Home Phone 707-580-6442 <br /> Work Phone 209-833-9050 <br /> District 005-ELLIOTT,BOB Location Code 03-TRACY <br /> APN 23303027 <br /> Date Abated �� — 2 A — t/\J Inspector ID <br /> ------------------------------------------------- - <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <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 /> omplaint Reviewed by: n Date: Up ated y: IDatejl ,l <br /> 5104.rpt �C• `j �y <br />