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vii Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00051953 Site Location: 2680 REYNOLDS RANCH PKWY Account ID: AR0036486 <br /> Received by: EE0006213 PEDRAZA Received Date: 5/13/2020 Print Date: 5/13/2020 2:23:14PM <br /> Assigned To: EE0007380 SHIH Assigned Date: 5/13/2020 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> E-Mail Address <br /> Nature of complaint: <br /> COMPLAINANT PURCHASED A BOX OF KIWI LAST TUESDAY. ATE THE KIWI ON 05/11/20,THEY BOTH <br /> BECAME ILL WITH SYMPTOMS OF VOMITING DIARRHEAAND LOW FEVER. THEY AT ITAT 9:OOAMAND BECAME ILL WITHIN HALF HOUR. <br /> THEY ARE BETTER TODAY. THEY DID NOT GO TO THE DOCTOR. COMPLAINANT ONLY WANT TO BE CALLED IF THERE ARE OTHER <br /> COMPLAINTS RELATED TO HIS ONE. <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 0-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> ---------------------------------------------- - -- - - <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0020431-COSTCO WHOLESALE#1091 RP DBA <br /> Site Location 2680 REYNOLDS RANCH PKWY RP mailing address <br /> LODI,CA 95240 <br /> Cross Street HARNEY LN <br /> Mailing address <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Date Abated ,/, ✓ <br /> Y �2 Inspector ID#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: Q <br /> Circle appropriate Status Code/U <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 /> 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 aint Reviewed by: ate: pate y: DION 19 <br /> 5104.rpt <br />