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Complaint Investigation Form Report#:5104 COMPLAINT ID: C00033093 Site Location: HOMESTEAD PASTA/ FD RECALL-C Account ID: Received by: EE0000467 CARRUESCO Received Date: 1/21/2011 Print Date: 1/21/2011 3:46:24PM Assigned To: EE0000467 CARRUESCO Assigned Date: 1/21/2011 Program/Element Code:1600-FOOD PROGRAM Complainant- : ENVIRONMENTAL HEALTH DEPT Home Phone Address :TIME TRACKING FOR FOOD RECALL Work Phone E-Mail Address Nature of complaint., COMPLAINT GENERATED TO TRACK EMPLOYEE TIME SPENT ON THE HOMESTEAD PASTA FOOD RECALL. `""NOTE: THIS IS SCANNED UNDER"UNKNOWN ADDRESS"IN THE"FOOD RECALL-COUNTYWIDE"FOLDER FOR QUESTYS, Complaint Mode: O Complaint Mode Codes A-Agency Referral B-Bd of Supervisors i City Council C-Counter F•Fax E-Cade Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone I-Intemet i Email S-Sheriffs Office ---------------------------------------------- -- PROPERTY INFORMATION PROPERTY OWNER INFORMATION Property Name: Responsible Party or Property Owner Site location HOMESTEAD PASTA FD RECALL RP/DSA RP Address Cross Street Billing Address Home Phone Phone Work Phone District Location Code APN Date Abated Z, I-Z f ! inspector: O Send Referral to Referral Letter Sent by Referral Address Date: i Complaint Status Code: a Zr Circle appropriate Status Code 01-FIELD ABATED 60-LEAD Assessment Performed-No Abatement Required 6 OFFICE ABATED 52-LEAD Abatement Reqired-See Program Record File 0$-NAI SENT 97-Disaster Planning and Response 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed 07-REFERRED TO OTHER AGENCY 08-UNABLE TO VERIFY 10-POSTED SUBSTANDARDIUNSECURED-See Housing File 11-Multiple Complaints-SEE ACTIVE CASE# f 12-DA Referred Complaint-See Violation Tracking Form 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# 28-FOODBORNE ILLNESS-No Major Violations Identified 29-FOODBORNE ILLNESS-Major Violations Identified 51 .rpt