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V Complaint Investigation Form Report# 5104 m COMPLAINT ID: C00039779 Site Location: 140 E HARDING WAY Account ID: AR0001468 Received by EE0000025 SEDRA Received Date: 6/1/2015 Print Date. 6/1/2015 12:02:55PM Assigned To: EE0008999 HUYNH Assigned Date: 6/1/2015 Program/Element Code 1600-FOOD PROGRAM Complainant: : EVA Home Phone 209-513-0900 Address :2105E MARIPOSA RD Work Phone STOCKTON,CA 95205 E-Mail Address Nature of complaint: PARTY OF 10 WERE AT FACILITY ON SATURDAY 5/30/2015 AT ABOUT 4:00 PM. RESTAURANT WAS VERY DIRTY.WINDOWS AND LEDGE WERE DIRTY,CARPET HAD FOOD ALL OVER IT AND THE BATHROOM WAS FILTHY. NO ONE BECAME ILL. Complaint Mode. P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone I-Internet/Email S-Sheriffs Office -------------------- --- FACILITY ------FACILITY INFORMATION OWNER INFORMATION Facility:FA0001469-GONGS RESTAURANT Owner: OWOOOI 146-LEI,PAUL Site Location 140 E HARDING WAY RP/DBA GONGS RESTAURANT STOCKTON,CA 95204 RP Address 5207 BARBADOS CT Cross Street HARDING STOCKTON,CA 95210 Mailing Address: 140 E HARDING WAY Billing Address 5207 BARBADOS CT STOCKTON,CA 95204 STOCKTON,CA 95210 Home Phone Phone :209-464-0953 Work Phone District 001-VILLAPUDUA,CARLOS Location Code 01-STOCKTON APN 13902015 Date Abated U/b /(� Inspector ID#: h Send Referral to Y Referral Letter Sent by Referral Address Date: Complaint Status Code: Circle appropriate Status Code 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found 07-REFERRED TO OTHER AGENCY CL-Case Closed 08-UNABLE TO VERIFY 10-POSTED SUBSTANDARD/UNSECURED-See Housing File 11-Multiple Complaints-SEE ACTIVE CASE# 12-DA Referred Complaint-See Violation Tracking Form omp amt Reviewed by ate: Date: I 104 ro+.