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Complaint Investigation Form Report #: 5104 <br />COMPLAINT ID: C00052855 Site Location: 4450 E WATERLOO RD <br /> <br />Account ID: AR0023837 <br /> <br />Received by: EE0000467 CARRUESCO <br />Assigned To: EE0009832 ACEVEDO <br />Program/Element Code 1600 - FOOD PROGRAM <br />Received Date: 10/26/2020 Print Date: 10/26/2020 8:32:42AM <br />Assigned Date: 10/26/2020 <br /> <br /> <br /> <br /> <br />Nature of complaint: <br /> <br />COMPLAINANT ALLEGES THIS FACILITY HAS SEVERAL VIOLATIONS AND HEALTH ISSUES. THE WHOLE PLACE IS FILTHY, DRAINS <br />CLOGGED AND SMELLS BAD, FOOD OPEN AND NOT CLEANED, FLOORS FILTHY, AND FLOOR DRAINS CLOGGED. <br />Complaint Mode: I 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: FA0014100 - KFC/A&W #284 <br />Site Location 4450 E WATERLOO RD <br />STOCKTON, CA 95215--230 <br />Cross Street WILCOX <br />Mailing address 2846 VOLPEY WAY <br />UNION CITY, CA 94587 <br />Phone 209-931-8994 EXT: <br />Owner: 0W0011163 - Froilan 284, Inc. <br />DBA <br />Owner address 8334 GERBER RD <br />SACRAMENTO, CA 95828 <br />Billing Address 2846 VOL PEY WAY <br />UNION CITY, CA 94587 <br />Home Phone 510-429-7925 <br />Work Phone 916-553-2267 EXT: <br />District 004 - WINN, CHARLES <br />APN 10102159 <br />RESPONSIBLE PARTY INFORMATION <br />RP DBA <br />RP mailing address <br />RP contact <br />RP contact phone <br />Location Code 99- UNINCORPORATED AREA <br />Date Abated o/12- 7<c) <br /> <br />Inspector ID #: <br /> <br />Send Referral to <br />Referral Address <br /> <br />Referral Letter Sent by <br />Date: <br /> <br />Complaint Status Code: 0k <br />Circle appropriate Status Code <br />6 _ Field 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 />"..s,omplaint Reviewed by: - <br />5104.rpt <br />Date: 1..))Updated by: <br /> <br />Date ( I (411A <br />