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omplaint Reviewed by: Date: <br />5104. rpt <br />Complaint Investigation Form <br />Report #: 5104 <br />COMPLAINT ID: C00052761 Site Location: 1327 W LOCKEFORD ST <br /> <br />Account ID: AR0000423 <br /> <br />Received by: EE0009830 SAUERS <br /> <br />Received Date: 10/6/2020 Print Date: 10/6/2020 4:28:27PM <br />Assigned To: EE0001084 RAMIREZ <br /> Assigned Date: 10/6/2020 <br />Program/Element Code 1600 - FOOD PROGRAM <br />Complainant: <br />Home Phone <br />E-Mail Address <br /> <br /> <br />Nature of complaint: <br />COMPLAINANT ALLEGES THE OWNER OF THIS FACILITY DOES NOT WEAR A MASK. THE EMPLOYEES AND CUSTOMERS WEAR ONE BUT <br />HE DOESN'T. COMPLAINANT ALLEGES HE WALKS AROUND FROM TABLE TO TABLE TALKING TO THE CUSTOMERS AND DOES NOT USE <br />ONE. <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: FA0000424 - COUNTRY KITCHEN <br />Site Location 1327 W LOCKEFORD ST <br />LODI, CA 95240 <br />Cross Street LOCKEFORD <br />Mailing address 1327 W LOCKEFORD <br />LODI, CA 95240 <br />Phone 209-368-6350 <br />Owner: 0W0000352 - XENOS, DENNIS T <br />DBA COUNTRY KITCHEN <br />Owner address 1944 ROSEBUD CT <br />SAN JOSE, CA 95128 <br />Billing Address 1944 ROSEBUD CT <br />SAN JOSE, CA 95128 <br />Home Phone 408-287-5934 <br />Work Phone 408-294-2262 <br />District 004 - WINN, CHARLES <br />APN 03533013 <br />Date Abated 0 1 I Lf I LOA) Inspector ID #: <br />RESPONSIBLE PARTY INFORMATION <br />RP DBA <br />RP mailing address <br />RP contact <br />RP contact phone <br />Location Code 02 - LODI <br />14/1. t <br />Send Referral to <br />Referral Address <br /> <br />Referral Letter Sent by <br />Date: <br /> <br />Complaint Status Code: <br />Circle appropriate Status Code <br />01 ield Response-Violations Cited and Corrected <br />02 - Office Response Only <br />06 - Violations Cited - see Linked PROGRAM FACILITY FILE <br />07 - Referred to Other Agency <br />08 - Unable 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: bl <br /> <br />Date !vitt <br />