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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00047666 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Received by: EE0009830 SAUERS Received Date. 10/25/2018 Print Date: 10/25/2018 2:53:06PM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 10/25/2018 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES HE WITNESSED A LARGE RAT RUN THROUGH THE DINING AREA.COMPLAINANT ALLEGES THERE WAS A PILE OF <br /> FLOUR AND RAW CHICKEN SITTING ON A COUNTER IN THE KITCHEN UNCOVERED AND UNATTENDED. FACILITY APPEARS TO HAVE <br /> UNSANITARY CONDITIONS. <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 O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility: FA0002725-CHURCHS CHICKEN#5773 Owner: OW0010559-H&R FOODS INC <br /> Site Location 8023 WEST LN RP/DBA CHURCH'S CHICKEN#5773 <br /> STOCKTON,CA 95210 RP Address 6248 PACIFIC AVE <br /> Cross Street WEST LANE STOCKTON,CA 95207 <br /> Mailing Address: 6248 PACIFIC AVE Billing Address 6248 PACIFIC AVE <br /> STOCKTON,CA 95207 STOCKTON,CA 95207 <br /> Home Phone :661-703-7298 EXT: CELL <br /> Phone :209-475-1547 Work Phone :209-475-1547 EXT: BUSINESS <br /> District 003-PATTI,TOM Location Code 01-STOCKTON <br /> APN 08818007 <br /> Date Abated I I— a� r 1,2 Inspector ID#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: () <br /> Circle appropriate Status Code <br /> 01 ield Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Reqired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> omplaint Reviewed by: -- ate: p ate y: Dat <br /> L4t2-- L7 <br /> 5104 rpt <br />